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*Orthopaedic Surgery > Orthopedic Physiology > Flashcards

Orthopedic Physiology Flashcards

1
Q

Stages of Intramembranous Ossification? 4

A
  1. An ossification center appears in the fibrous connective tissue membrane
  2. Bone matrix is secreted within the fibrous membrane
  3. Woven bone and periosteum form
  4. Bone collar of compact bone forms, and red marrow appears
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2
Q

How does the ossification center form?

A
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3
Q

Bone matrix is secreted within the fibrous membrane

  1. What is another name for bone matrix?
  2. What secretes this? It is mineralized in what time period?
  3. Trapped osteoblasts become what?
A
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4
Q

Woven bone and periosteum form:

  1. Accumulating osteoid is laid down b/w embyronic blood vessels which form a random network. The result is?

2 What becomes the periosteum?

A
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5
Q

Bone collar of compact bone forms, and red marrow appears:

  1. Trabeculae just deep to the periosteum thicken, forming a woven bone collar that is later replaced with what?
  2. What persists internally and its vascular tissue becomes red marrow?
A
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6
Q

Endochondral Ossification

  1. Begins when?
  2. Uses what as models for bone construction?
  3. Requires what prior to ossification?
A
  1. Begins in the second month of development
  2. Uses hyaline cartilage “bones”
  3. Requires breakdown of hyaline cartilage prior to ossification
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7
Q

Stages of Endochondral Ossification

5

A
  1. Formation of bone collar
  2. Cavitation of the hyaline cartilage
  3. Invasion of internal cavities by the periosteal bud, and spongy bone formation
  4. Formation of the medullary cavity; appearance of secondary ossification centers in the epiphyses
  5. Ossification of the epiphyses, with hyaline cartilage remaining only in the epiphyseal plates
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8
Q

Postnatal Bone Growth: Growth in length of long bones

  1. Cartilage on the side of the where is relatively inactive?
  2. Cartilage abutting the shaft of the bone organizes into a pattern that allows what?
  3. Cells of the epiphyseal plate proximal to the resting cartilage form three functionally different zones: what are they?
A
  1. epiphyseal plate closest to the epiphysis
  2. fast, efficient growth

3.

  • growth,
  • transformation
  • osteogenic development
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9
Q

Functional Zones in Long Bone Growth

Define the following zones:

  1. Growth zone?
  2. Transformation?
  3. Osteogenic zone?
A
  1. Growth zone – cartilage cells undergo mitosis, pushing the epiphysis away from the diaphysis
  2. Transformation zone – older cells enlarge, the matrix becomes calcified, cartilage cells die, and the matrix begins to deteriorate
  3. Osteogenic zone – new bone formation occurs
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10
Q

Long Bone Growth and Remodeling

  1. Growth in length – cartilage continually grows and is replaced by what?
  2. What is Remodeling?
A
  1. bone
  2. – bone is resorbed and added by appositional growth as shown
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11
Q

Where are the places where cartilage is grown? 2 And then replaced by bone? 2

Where is bone reabsorbed? 2 Where is bone added and by what?

A
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12
Q

What are the 4 stages of appositional bone growth?

A
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13
Q

Hormonal Regulation of Bone Growth During Youth

  1. During infancy and childhood, epiphyseal plate activity is stimulated by what?
  2. What changes occur during puberty because of estrogen and testosterone in the skeleton system? 3
A
  1. Growth hormone

2.

  • Initially promote adolescent growth spurts
  • Cause masculinization and feminization of specific parts of the skeleton
  • Later induce epiphyseal plate closure, ending longitudinal bone growth
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14
Q

What are remodeling units?

A

§Remodeling units – adjacent osteoblasts and osteoclasts deposit and resorb bone at periosteal and endosteal surfaces

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15
Q

Bone Deposition

  1. Occurs where?
  2. Requires a diet rich in what? 8
  3. What is essential for mineralization of bone?
  4. Sites of new matrix deposition are revealed by the what? 2 (Describe what these are)
A
  1. bone is injured or added strength is needed
  2. protein, vitamins C, D, and A, calcium, phosphorus, magnesium, and manganese
  3. Alkaline phosphatase

4.

  • Osteoid seam – unmineralized band of bone matrix
  • Calcification front – abrupt transition zone between the osteoid seam and the older mineralized bone
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16
Q

Bone Resorption

  1. Accomplished by what?
  2. What are reabsorption bays?
  3. Resorption involves osteoclast secretion of? 2
  4. Dissolved matrix is transcytosed scross the osteoclast’s cell where it is secreted where?
A
  1. Accomplished by osteoclasts
  2. Resorption bays – grooves formed by osteoclasts as they break down bone matrix
  3. Resorption involves osteoclast secretion of:
    - Lysosomal enzymes that digest organic matrix
    - Acids that convert calcium salts into soluble forms
  4. into the interstitial fluid and then into the blood
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17
Q

Importance of Ionic Calcium in the Body

Calcium is necessary for? 5

A
  1. Transmission of nerve impulses
  2. Muscle contraction
  3. Blood coagulation
  4. Secretion by glands and nerve cells
  5. Cell division
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18
Q

Control of Remodeling: Two control loops regulate bone remodeling?

A
  1. Hormonal mechanism maintains calcium homeostasis in the blood
  2. Mechanical and gravitational forces acting on the skeleton
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19
Q

Hormonal Mechanism

  1. Rising blood Ca2+ levels trigger the thyroid to release what?
  2. Calcitonin stimulates what?
  3. Falling blood Ca2+ levels signal what?
  4. PTH signals osteoclasts to do what? 2
A
  1. calcitonin
  2. calcium salt deposit in bone
  3. the parathyroid glands to release PTH

4.

  • degrade bone matrix
  • release Ca2+ into the blood
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20
Q

Response to Mechanical Stress

  1. What is wolff’s law?
  2. Observations supporting Wolff’s law include? 2
A
  1. Wolff’s law – a bone grows or remodels in response to the forces or demands placed upon it
  2. Observations supporting Wolff’s law include
    - Long bones are thickest midway along the shaft (where bending stress is greatest)
    - Curved bones are thickest where they are most likely to buckle
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21
Q

Response to Mechanical Stress

  1. Trabeculae form along lines of what?
  2. Large, bony projections occur where?
A
  1. stress
  2. where heavy, active muscles attach
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22
Q

Bone fractures are classified by: 4

A
  1. The position of the bone ends after fracture
  2. The completeness of the break
  3. The orientation of the bone to the long axis
  4. Whether or not the bones ends penetrate the skin
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23
Q

Types of Bone Fractures: Describe the following

  1. Nondisplaced?
  2. Displaced?
  3. Complete?
  4. Incomplete?
  5. Linear?
  6. Transverse?
  7. Compound/open?
  8. Simple/closed?
A
  1. Nondisplaced – bone ends retain their normal position
  2. Displaced – bone ends are out of normal alignment
  3. Complete – bone is broken all the way through
  4. Incomplete – bone is not broken all the way through
  5. Linear – the fracture is parallel to the long axis of the bone
  6. Transverse – the fracture is perpendicular to the long axis of the bone
  7. Compound (open) – bone ends penetrate the skin
  8. Simple (closed) – bone ends do not penetrate the skin
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24
Q

Common Types of Fractures: Describe the following types

  1. Comminuted?
  2. Spiral?
  3. Depressed?
  4. Compression?
  5. Epiphyseal?
  6. Greenstick?
A
  1. Comminuted – bone fragments into three or more pieces; common in the elderly
  2. Spiral – ragged break when bone is excessively twisted; common sports injury
  3. Depressed – broken bone portion pressed inward; typical skull fracture
  4. Compression – bone is crushed; common in porous bones
  5. Epiphyseal – epiphysis separates from diaphysis along epiphyseal line; occurs where cartilage cells are dying
  6. Greenstick – incomplete fracture where one side of the bone breaks and the other side bends; common in children
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25
Q
A
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26
Q

Stages in the Healing of a Bone Fracture

First: Hematoma Formation

Describe the three steps in this?

A
  1. Torn blood vessels hemorrhage
  2. A mass of clotted blood (hematoma) forms at the fracture site
  3. Site becomes swollen, painful, and inflamed
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27
Q

Stages in the Healing of a Bone Fracture:

Second: Fibrocartilaginous callus formation

Describe the three steps in this?

A
  1. Fibrocartilaginous callus forms
  2. Granulation tissue (soft callus) forms a few days after the fracture
  3. Capillaries grow into the tissue and phagocytic cells begin cleaning debris
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28
Q

Stages in the Healing of a Bone Fracture

The fibrocartilaginous callus forms when:

4

A
  1. Osteoblasts and fibroblasts migrate to the fracture and begin reconstructing the bone
  2. Fibroblasts secrete collagen fibers that connect broken bone ends
  3. Osteoblasts begin forming spongy bone
  4. Osteoblasts furthest from capillaries secrete an externally bulging cartilaginous matrix that later calcifies
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29
Q

Stages in the Healing of a Bone Fracture

Bone callus formation

What are the 3 steps in this?

A
  1. New bone trabeculae appear in the fibrocartilaginous callus

  1. Fibrocartilaginous callus converts into a bony (hard) callus
  2. Bone callus begins 3-4 weeks after injury, and continues until firm union is formed 2-3 months later
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30
Q

Stages in the healing of a bone fracture

Bone remodeling

2 steps?

A
  1. Excess material on the bone shaft exterior and in the medullary canal is removed

  1. Compact bone is laid down to reconstruct shaft walls
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31
Q
  1. What is osteomalacia?
  2. Main symptom?
  3. Caused by?
A
  1. Bones are inadequately mineralized causing softened, weakened bones
  2. Main symptom is pain when weight is put on the affected bone
  3. Caused by insufficient calcium in the diet, or by vitamin D deficiency
32
Q

OSTEOMALACIA AND RICKETS

  1. PP?
  2. What happens to the bones?
  3. Usually due to?
  4. Five signs of rickets?
A
  1. Bones inadequately mineralized
  2. Become soft and deformed
  3. Usually due to vitamin D deficiency
33
Q

Rickets

  1. Bones of children are inadequately mineralized causing what?
  2. Bowed legs and deformities of the what are common? 3
  3. Caused by what? 2
A
  1. softened, weakened bones

2.

  • pelvis,
  • skull, and
  • rib cage

3.

  • insufficient calcium in the diet
  • by vitamin D deficiency
34
Q

Osteoporosis

  1. What is it?
  2. What is most vulnerable?
  3. Occurs most often in who?

Bones become so fragile that sneezing or stepping off a curb can cause fractures

A
  1. Group of diseases in which bone reabsorption outpaces bone deposit
  2. Spongy bone of the spine
  3. postmenopausal women
35
Q

OSTEOPOROSIS

  1. Basic PP?
  2. Bones become what?
A
  1. Resorption exceeds formation
  2. Bones become weak and porous
36
Q

Osteoporosis: Treatment

5

A
  1. Calcium and vitamin D supplements
  2. Increased weight-bearing exercise
  3. Hormone (estrogen) replacement therapy (HRT) slows bone loss
  4. Natural progesterone cream prompts new bone growth
  5. Statins increase bone mineral density
37
Q
  1. Paget’s Disease: Characterized by what?
  2. Pagetic bone with an excessively high ratio of what bone is formed?
  3. Pagetic bone, along with what, causes spotty weakening of bone?
  4. Which activity wanes and which continues to work?
A
  1. Characterized by excessive bone formation and breakdown
  2. woven to compact bone is formed
  3. reduced mineralization, causes spotty weakening of bone
  4. Osteoclast activity wanes, but osteoblast activity continues to work
38
Q

Paget’s Dz

  1. Usually localized where? 4
  2. Cause?
  3. Tx? 2
A
  1. Usually localized in the
    - spine,
    - pelvis,
    - femur
    - skull
  2. Unknown cause (possibly viral)
  3. Treatment includes the drugs Didronate and Fosamax
39
Q

Paget’s

  1. excessive and abnormal remodeling leads to?
  2. May develop what? 2
  3. What can help? 2
A
  1. Excessive and abnormal remodeling - - > misshapen bones
  2. May develop
    - arthritis
    - deafness

3.

  • Bisphosphonates
  • calcitonin help
40
Q

Developmental Aspects of Bones

  1. Mesoderm gives rise to embryonic mesenchymal cells, which produce what?
  2. The embryonic skeleton ossifies in a predictable timetable that allows what?
  3. At birth, most long bones are well ossified, except for what?
A
  1. membranes and cartilages that form the embryonic skeleton
  2. fetal age to be easily determined from sonograms
  3. their epiphyses
41
Q

Developmental Aspects of Bones

  1. By age ___, nearly all bones are completely ossified
  2. In old age, bone ________ predominates
  3. A single gene that codes for vitamin D docking determines both the tendency for? 2
A
  1. 25
  2. resorption

3.

  • accumulate bone mass early in life
  • the risk for osteoporosis later in life
42
Q

TENDONS AND LIGAMENTS

  1. Ligaments connect what?
  2. Functions?
  3. Tendons connect what?
  4. Allows for what?
  5. Comprised of what?
A
  1. bone to bone
  2. Provide stability and limit motion in a joint
  3. muscle to bone
  4. motion at a joint
  5. parallel collagen fibers
43
Q
  1. Tendinitis to tendon ruptures happen how? 2 and how do you treat each?
  2. Strains, sprains, and tears: Should be managed how? 2
  3. What is it: Bursitis?
  4. What are the deep bursitis? 2
  5. Superficial? 2
A

1.

  • Overuse injuries – usually respond to rest
  • Acute injuries – may need surgical repair

2.

  • Partial injuries will heal if protected
  • Complete injuries often need surgical repair

3.

Inflammation from overuse

  1. Deep: greater trochanteric and rotator cuff
  2. Superficial: olecranon and pre-patellar
44
Q

Muscle and Nerve

The contractile cells of the body can be classified into three major groups based on their what? 4

A
  1. Shape
  2. Number and position of nuclei
  3. Presence of striations
  4. And whether they are under voluntary or involuntary control
45
Q

Describe the following for Skeletal muscle, Cardiac, and Smoooth:

  1. Cell shape?
  2. Nuclei?
  3. Striations?
  4. Voluntary or involuntary?
46
Q

Describe the following for Skeletal, Cardiac, and Smooth muscle:

  1. Body function
  2. Cell shape and appearance?
47
Q

Skeletal muscle function

4

A
  1. Movement of bones or fluids
  2. Maintaining posture and body position
  3. Stabilizing joints
  4. Heat generation
48
Q

Skeletal muscle: Each muscle is served by what? 3

A
  1. one artery,
  2. one nerve, and
  3. one or more veins
49
Q

Connective tissue sheaths of skeletal muscle are? 3

Describe each

A
  1. Epimysium: dense regular connective tissue surrounding entire muscle
  2. Perimysium: fibrous connective tissue surrounding fascicles (groups of muscle fibers)
  3. Endomysium: fine areolar connective tissue surrounding each muscle fiber
50
Q

Describe the following and also the connective tissue wrapping around it:

  1. Muscle?
  2. Fascicle?
  3. Muscle fiber?
51
Q

Microscopic Anatomy of a Skeletal Muscle Fiber

What does it contain? 7

A
  1. Cylindrical cell 10 to 100
  2. Multiple peripheral nuclei
  3. Many mitochondria
  4. Glycosomes
  5. Contain myofibrils,
  6. sarcoplasmic reticulum, and
  7. T tubules
52
Q
  1. What are myofibrils?
  2. What percent of the cell volume do they make up?
  3. Exhibit striations divided into? 2
A
  1. Densely packed, rodlike elements
  2. ~80% of cell volume
  3. Exhibit striations: dark A bands and light I bands
53
Q
  1. What is a sarcomere?
  2. The region of a myofibril is where?
  3. Composed of? 2
A
  1. Smallest contractile unit (functional unit) of a muscle fiber
  2. The region of a myofibril between two successive Z discs
  3. Composed of thick and thin myofilaments made of contractile proteins
54
Q

Describe the structures of a sarcomere?

8

55
Q

Features of the sarcomere:

Define the following?

  1. Thick filaments?
  2. Thin filaments?
  3. Z disc?
  4. H zone?
  5. M line?
  6. Sarcomere?

Z-discs are pulled toward each other by:

A
  1. run the entire length of an A band
  2. run the length of the I band and partway into the A band
  3. coin-shaped sheet of proteins that anchors the thin filaments and connects myofibrils to one another
  4. lighter midregion where filaments do not overlap
  5. line of protein myomesin that holds adjacent thick filaments together
  6. The fundamental unit which allows contraction of the muscle to take place
56
Q

Ultra-structure of Thick Filament

  1. Composed of what? Specifically? 2

Ultra-structure of Thin Filament

  1. ________ bears active sites for myosin head attachment during contraction
  2. What are the regulatory proteins bound to actin?
A
  1. Composed of the protein myosin
    - Myosin tails
    - Myosin heads
  2. G actin
  3. Tropomyosin and troponin
57
Q
  1. What is Sarcoplasmic Reticulum (SR)?
  2. What does it form?
  3. Functions in?

T Tubules

  1. Continuous with?
  2. Penetrate the cell’s interior where?
  3. Paired terminal cisternae to form what?
A
  1. Network of smooth endoplasmic reticulum
  2. Pairs of terminal cisternae form perpendicular cross channels
  3. Functions in the regulation of intracellular Ca2+ levels

T Tubules

  1. Continuous with the sarcolemma
  2. Penetrate the cell’s interior at each A band–I band junction
  3. Paired terminal cisternae to form triads that encircle each sarcomere
58
Q

Sliding Filament Model of Contraction

  1. In the relaxed state, thin and thick filaments overlap how?
  2. During contraction, myosin heads do what?
  3. As H zones shorten and disappear, what shortens? 3
A
  1. only slightly
  2. bind to actin, detach, and bind again, to propel the thin filaments toward the M line

3.

  • sarcomeres shorten,
  • muscle cells shorten,
  • and the whole muscle shortens
59
Q

“Sliding Filament” Mechanism

Describe it

60
Q

Requirements for Skeletal Muscle Contraction

2

A
  1. Activation: neural stimulation at a neuromuscular junction
  2. Excitation-contraction coupling: Generation and propagation of an action potential along the sarcolemma
61
Q

Neuromuscular Junction

  1. Situated where?
  2. Parts of the Junction? 3
A
  1. Situated midway along the length of a muscle fiber

2.

  • Synaptic cleft
  • Synaptic vesicles of axon terminal contain the neurotransmitter acetylcholine (ACh)
  • Junctional folds of the sarcolemma contain ACh receptors
62
Q

Events at the Neuromuscular Junction

7

A
  1. Skeletal muscles are stimulated by somatic motor neurons
  2. Axons of motor neurons travel from the central nervous system via nerves to skeletal muscles
  3. Each axon forms several branches as it enters a muscle
  4. Each axon ending forms a neuromuscular junction with a single muscle fiber
  5. Nerve impulse arrives at axon terminal
  6. AcH released (binds with receptors)
  7. Generation of AP
63
Q

Describe What happens at the neuromuscular junction for contraction to happen?

64
Q

Draw the graph that illustrated depolarization and repolarization in muscle contraction

65
Q

What are the ACh receptors in the body? 2

66
Q

Acetylcholine Receptor Antibody

  1. What is this?
  2. Describe what this results in? 4
A
  1. An autoimmune disease where an antibody is directed against the Acetylcholine Receptor is responsible for the symptoms that a person experiences who has Myasthenia Gravis
67
Q

Which step is affected in Myasthenia gravis?

  1. Motoneuron action potential at nerve terminal
  2. Ca++ influx causes release of Acetylcholine (ACh)
  3. ACh binds to AChR opening ion channel
  4. Na+ movement causes depolarization of end plate
  5. Muscle fibers depolarize which leads to muscle contraction!
A
  1. ACh binds to AChR opening ion channel
68
Q

Which step is affected in neuromuscular blockers?

  1. Motoneuron action potential at nerve terminal
  2. Ca++ influx causes release of Acetylcholine (ACh)
  3. ACh binds to AChR opening ion channel
  4. Na+ movement causes depolarization of end plate
  5. Muscle fibers depolarize which leads to muscle contraction!
A
  1. ACh binds to AChR opening ion channel
69
Q

Which step is affected in Botulinum Toxin?

  1. Motoneuron action potential at nerve terminal
  2. Ca++ influx causes release of Acetylcholine (ACh)
  3. ACh binds to AChR opening ion channel
  4. Na+ movement causes depolarization of end plate
  5. Muscle fibers depolarize which leads to muscle contraction!
A
  1. Ca++ influx causes release of Acetylcholine (ACh)
70
Q

Which step is affected in Multiple Sclerosis?

  1. Motoneuron action potential at nerve terminal
  2. Ca++ influx causes release of Acetylcholine (ACh)
  3. ACh binds to AChR opening ion channel
  4. Na+ movement causes depolarization of end plate
  5. Muscle fibers depolarize which leads to muscle contraction!
A
  1. Motoneuron action potential at nerve terminal
71
Q

What does this process require? 2

  1. Motoneuron action potential at nerve terminal
  2. Ca++ influx causes release of Acetylcholine (ACh)
  3. ACh binds to AChR opening ion channel
  4. Na+ movement causes depolarization of end plate
  5. Muscle fibers depolarize which leads to muscle contraction!
A

Process

requires ATP and

magnesium

72
Q

EC Coupling - Comparison

Describe for Skeletal and Cardiac Muscle

  1. Trigger?
  2. T-tuble?
  3. Ryanodine receptor?
  4. Ca release proportional to what?
A

Skeletal Muscle

  1. The trigger for SR release is voltage (Voltage Activated Calcium Release - VACR).
  2. The t-tubule membrane has a voltage sensor (DHP receptor)
  3. The ryanodine receptor is the SR Ca release channel
  4. Ca release is proportional to membrane voltage

Cardiac Muscle

  1. The trigger for SR release is calcium (Calcium Activated Calcium Release – CACR).
  2. The t-tubule membrane has a Ca channel (DHP receptor)
  3. The ryanodine receptor is the SR Ca release channel
  4. The ryanodine receptor is Ca gated and Ca release is proportional to Ca entry.
73
Q

Define the following:

  1. Sarcolemma?
  2. Sarcoplasma?
  3. Motor end plate?
  4. T tubule?
  5. Cisternae?
  6. Myofibrils?
A
  1. muscle cell membrane
  2. muscle cell cytoplasm
  3. contact surface with axon terminal
  4. cell membrane extension into the sarcoplasm (to reach the myofibrils)
  5. areas of the ER dedicated to Ca++ storage (located on each side of the T-tubules)
  6. organized into sarcomeres
74
Q

Describe the breakdown of ATP in short duration compared to long duration exercise?

75
Q

Synaptic events:

  1. The AP reaches the ______ bulb
  2. Voltage-gated what open?
  3. The influx of calcium in the bulb activates enzymes → leads to?
  4. Neurotransmitter for skeletal muscles is always what?
  5. The receptors on the muscle fiber are what receptors?
  6. These receptors are what kind?
A
  1. axonal
  2. calcium channels
  3. the vesicles containing the neurotransmitter molecule dock and release the neurotransmitter in the synapse
  4. acetylcholine
  5. cholinergic
  6. nicotinic (fast) acting receptors

*Orthopaedic Surgery (28 decks)

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