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Medicine > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What connects the radius and ulna

A

The interosseous membrane

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2
Q

What are the articulation points of the ulna

A
  • Troclear notch of ulna –> trochlea of humerus
  • Head of ulna –> ulnar notch of radius = radio-ulnar joint
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3
Q

What is the wrist called

A

the radiocarpal joint - the radius articulates with 2 of the carpals

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4
Q

How many bones make up the carpals

A

8

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5
Q

What are the articulation points of the radius

A
  • Elbow joint = Radial head + capitellum of the humerus
  • Proximal radioulnar joint = radial head + radial notch of ulna
  • Distal radioulnar joint = ulnar head + ulnar notch of radius
  • Radiocarpal joint = distal radius + scaphoid and lunate
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6
Q

What is the most commonly fractured carpal bone

A

The scaphoid from a fall on an outstretched hand

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7
Q

What is the order of bones in the hand

A

Capals, metacarpals, phalanges

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8
Q

How many phalanges are in the hand

A

3 per finger - proximal, middle and distal
2 per thumb - proximal and distal

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9
Q

What passes through the cubital fossa

A

Biceps tendon, median nerve, brachial artery (becomes radial and ulnar), superficial veins - median cubital from which blood is drawn

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10
Q

How many muscles are there in the anterior compartment of the forearm

A

8 - in superficial, middle, and deep layers

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11
Q

How can the anterior muscles be generalised and what are the exceptions

A
  • All flexors, except pronator teres and pronator quadratus
  • All innervated by the median nerve, except flexor carpi ulnaris - ulnar
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12
Q

Where do the superficial muscles of the anterior compartment of the forearm originate

A

The medial epicondyle

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13
Q

What is the medial epicondyle referred to as

A

The common flexor origin

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14
Q

What is the middle layer of the anterior compartment of the forearm

A

Flexor digitorum superficials - it gives rise to 4 tendons

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15
Q

How many muscles are in the deep layer of the anterior compartment of the forearm

A

3

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16
Q

Pattern of number of muscles in the anterior compartment of the forearm

A

4,1,3 - Before I try

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17
Q

What does the flexor retinaculum do

A

Stops the tendons from bowstringing

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18
Q

What causes carpal tunnel syndrome

A

The compression of the medial nerve from swelling

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19
Q

What is the course of the radial and ulnar arteries

A

Radial artery = lateral
Ulnar artery = medial

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20
Q

What happens when the radial and ulnar arteries enter the hand

A

The anastomose to form the palmar arches
Superficial = mostly ulnar
Deep = mostly radial

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21
Q

What are the two bumps on the wrist

A

Big one = pisiform
Slightly higher, small one = hook of hamate

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22
Q

What are the forms of calcium

A

99% bone
1% extracellular

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23
Q

How much calcium is there in the body

A

1200mg

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24
Q

What molecules regulate calcium level/bone metabolism

A

Calcitriol, parathyroid hormone and calcitonin

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25
Q

Calcitriol vs vit D

A

Calcitriol is the hormonally active form of vitamin D

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26
Q

What protein is calcium usually bound to when in the blood

A

Albumin –> lack of albumin mean free Ca2+ increases

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27
Q

Where is parathyroid hormone secreted from

A

Chief cells in the parathyroid glands

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28
Q

What does parathyroid hormone do (calcium)

A

increase serum Ca2+ levels

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29
Q

How does the parathyroid hormone detect Ca2+ levels

A

Ca2+ sensing receptors

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30
Q

What is the action of PTH

A

Bone: Stimulates osteoclasts, inhibits osteoblasts –> resorption
Kidneys: Increases Ca2+ reabsorption. Increases phosphate excretion –> so it does not combine w Ca2+ to form bone
GI tract: Increases calcidiol gets converted to calcitriol which increases Ca2+ absorption

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31
Q

What does Calcitriol do (calcium)

A

Increase Ca2+ absorption from GI tract

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32
Q

What is the action of caclitriol

A

Increases the number of calcium transporters on wall of GI tract

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33
Q

How does pH affect calcium levels

A

Alkalosis = albumin binds more strongly to Ca2+ –> decreases free calcium levels
Acidosis = albumin binds less strongly to Ca2+ –> increases free calcium levels

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34
Q

Where is calcium absorbed

A

Active via duodenum and jejunum
Passive via ileum and colon

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35
Q

Where is the majority of calcium reabsorbed

A

in the proximal convoluted tubule

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36
Q

Where is vitamin D converted to calcitriol

A

Kidneys

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37
Q

What does calcitonin do

A

Inhibits osteoclasts so decreases bone resorption -> increases Ca2+ levels
(but minor effect)

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38
Q

How does cartilage grow

A

Both appositionally and interstitially

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39
Q

What is ossification

A

the formation of bone

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40
Q

What are the 2 types of ossification

A

1) Endochondrial ossification
2) Intramembranous ossification

41
Q

What is endochondral ossification

A

hyaline cartilage is created from mesenchyme then replaced with bone

42
Q

What is intramembranous ossification

A

When bone develops directly from mesenchyme

43
Q

What bones are formed from endochondrial ossification

A

All bones below the skull except the clavicles

44
Q

What is the process of endochondral ossification

A

1) Chondrocytes create a hyaline cartilage model of bone
2) Mineralisation occurs (matrix filled with calcium phosphate)
3) Chondrocytes die, creating space in the bone called lacunae
4) Lacunae become filled w osteoblasts which create new bone

45
Q

Where is the primary ossification centre

A

The shaft of long bones

46
Q

What are growth plates

A

Ends of bones where cartilage remains so longitudinal growth can continue

47
Q

Process of intramembranous ossification

A

1) Mesenchymal cells condense into sheets
2) They differentiate into osteoblast precursors and capillaries
3) Osteoblasts deposit calcium phosphate
4) Osteoblasts become osteocytes
5) Compact bone is formed

48
Q

What is modelling drift

A

The process by which bone becomes wider/curved –> bone remodelling

49
Q

What is osteonal tunnelling

A

The remodelling of cortical bone - outer layer of long bones- to replace old bone

50
Q

What is the sarcoplasm rich in?

A

Glycogen

51
Q

What is the size of a myofiber?

A

Diameter = 1000um
Length = 5cm

52
Q

What cells fuse to produce muscle fibres

A

Myoblasts

53
Q

What is the order of skeletal muscle structure

A

Sarcomere –> Myofibril –> Myofiber (muscle cell) –> Sarcolemma –> Endomysium (connective tissue between muscle fibres) –> Perimysium (forms fascicle) –> Epimysium

54
Q

What does titin do

A

It connects the z line to the m line. Keeps the myosin in the centre and allows the muscle to stretch

55
Q

What does nebulin associate with

A

actin

56
Q

How many myosin heads are there per myosin filament

A

300

57
Q

What do tentanus and botulism toxins do

A

Prevent the release of Ach at the neuromuscular junction

58
Q

Slow oxidative fibres traits

A
  • Aerobic conditions
  • lots of mitochondria
  • low glycogen content –> ATP source is aerobic respiration
  • fatigue resistant
59
Q

How many ATP molecules are produced per glucose for aerobic respiration

A

38

60
Q

How many ATP are produced per glucose during anaerobic respiration

A

2

61
Q

What is an exception of the muscle to bone tendon rule

A

the patellar tendon

62
Q

What are the similarities between tendons and ligaments

A
  • Dense connective tissue in parallel
  • Produced by fibroblasts (tenocytes)
  • The extracellular matrix makes up 80%
  • Poorly vascularised
63
Q

Ligament v tendon

A
  • Ligaments have less collagen
  • Ligaments have more elastin
  • Ligament fibre organisation is more random
  • Blood supply different
64
Q

What has more elastin, ligament or tendon?

A

Ligament

65
Q

What does the crimping of the ligaments allow

A

Enables the ligament to increase in length under tension

66
Q

What is the hierarchy of tendon/ligament structure

A

Tropocollagen –> Collagen molecules –> Microfibril –> Subfibril –> Fibril –> Fibres –> Fascicle –> Endotenon –> Paratenon

67
Q

What is the main component of t + l

A

Type 1 collagen (95%) + proteoglycans

68
Q

What do proteoglycans do in t+l

A

Lubrication

69
Q

What is the structure of collagen

A
  • 3 alpha chains coiled individually in a left hand helix
  • The 3 individual chains coil together in a right hand helix
70
Q

Where is collagen assembled

A

extracellularly

71
Q

What is the insertion of a L/T into a bone called

A

Enthesis

72
Q

Types of enthesis

A

1) Fibrous insertion = intramembranous ossification via sharpeys fibres
2) Fibrocartilage insertion = endochondral ossification via fibrocartilage, then bone

73
Q

What are the embryological differences between intramembranous to endochondral ossification

A

Intramembranous ossification = directly ossified
Endochondral ossification = to cartilage then bone

74
Q

How do muscles connect to tendons

A
  • The muscle cells become more convoluted with a larger surface area
  • The collagen fibres can then attach in
75
Q

How does tendon/ligament strength increase

A

Mobilisation - mechanical demands

76
Q

What are the types of joints (structural)

A

Fibrous, cartilaginous, synovial

77
Q

What are the types of joints (functional)

A

1) Synarthroses (Fibrous)
2) Amphiarthroses (Cartilaginous)
3) Diarthroses (Synovial)

78
Q

What are examples of fibrous joints

A
  • Sutures = bones bound together by sharpeys fibres. Only in skull
  • Syndesmoses = when bones are connected by an interosseous membrane
  • Gomphoses = peg and socket joint. Only in tooth articulation
79
Q

Types of cartilaginous joints

A

1) Synchondrosis = only have hyaline cartilage e.g. costal cartilage
2) Symphysis = includes a plate of fibrocartilage e.g. intervertebral disc

80
Q

What are the 3 types of cartilage

A

Hyaline (articular), elastic, fibrocartilage

81
Q

What type of collagen is found in cartilage

A

type II

82
Q

What is the solubility of uric acid

A
  • Poorly soluble in plasma
  • Lower the ph, the less soluble
83
Q

What are the sources of purines

A
  • Dietary purines
  • Tissue nucleotides
  • Purine synthesis
84
Q

Why do men get gout more than women

A

Oestrogen increases excretion

85
Q

Where are dietary proteins found

A
  • Meat
  • Seafood
  • Soya
  • Oatmeal
86
Q

What is the key enzyme in uric acid formation

A

Xanthine oxidase (Purine –> Xanthine –> Uric acid)

87
Q

What can high uric acid damage

A
  • Joints
  • Kidneys - kidney stones
88
Q

Why can cancer cause increased uric acid levels

A

Increased tissue breakdown

89
Q

What enzyme recycles purines

A

HPRT

90
Q

What are the purines

A

Adenine, Guanine, Hypoxanthine, Xanthine

91
Q

What is the end produce of purine metabolism

A

uric acid

92
Q

Normal uric acid levels

A

Men = 200-430 umol/L
Women = 140-360 umol/L

93
Q

D) Fracture

A

A breach in the continuity of bone

94
Q

What age is peak bone density

A

30

95
Q

What are examples of metabolic bone diseases

A

Osteoporosis, Pagets disease, Osteogenesis imperfecta

96
Q

Intra articular vs extra articular fractures

A

Joint involvement

97
Q

What is the epiphyses of a bone

A

The end part

98
Q

What are the stages of fracture healing

A

1) Haematoma (hrs) = bleeding, periosteal stripping
2) Inflammation (days) = platelets, osteoclasts reabsorb dead bone, mesenchymal stem cells
3) Repair (weeks) = callus formation, mineralisation
4) Remodelling (years) = increased bone strength, vascularity

Medicine (15 decks)

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