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MSK > Physiological > Flashcards

Physiological Flashcards

1
Q

What three types of muscle tissue is there?

A

Cardiac

Skeletal

smooth

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2
Q

Which muscle tissue are striated?

A

Skeletal and cardiac

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3
Q

What are the dark bands in striated muscle caused by?

A

Myosin thick filaments

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4
Q

what are the thin bands in striated muscle caused by?

A

Actin thin filaments

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5
Q

Which muscle tissue are involunatry?

A

smooth and cardiac - ANS

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6
Q

what is the difference between cardiac and striated muscle?

with regards to initiation and propagation of contraction?

A
  1. Skeletal muscle - neurogenic initiation of contractionCardiac muscle - myogenic initiation of contraction
  2. Skeletal muscle has neuromuscular junction cardiac muscle doesn’t
  3. Skeletal muscle does not have gap junctions cardiac muscle does
  4. skeletal muscles have motor units cardiac muscle does not
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7
Q

what is the difference between cardiac and striated muscle?

with regards to Excitation Contraction Coupling?

A
  1. skeletal: Ca++ entirely from sarcoplasmic reticulum

2. Cardiac: Ca++ from ECF and sarcoplasmic reticulum (Ca++ induced Ca++ release)

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8
Q

what is the difference between cardiac and striated muscle?

with regards to gradation of contraction?

A

Skeletal: depends on
(1) motor unit recruitment (2) summation of contractions

cardiac: depends on extent of preload (amount of blood filled in heart chambers)

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9
Q

What neurotransmitter is used in a neuromuscular junction for skeletal muscles?

A

ACh (acetylcholine)

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10
Q

what do skeletal muscle fibres organise into?

A

motor units

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11
Q

What is a motor unit?

A

a single alpha motor neuron and all the skeletal muscle fibres it innervates

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12
Q

Which muscle may have less motor units?

A

muscles which serve fine movement e.g. external eye muscle and intrinsic hand muscles

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13
Q

Discuss the organisation of a whole muscle.

A
  1. sarcomere
  2. Many sarcomeres make up a MYOFIBRIL
  3. Many myofibrils make up a MUSCLE FIBRE
  4. Many muscle fibres make up a WHOLE MUSCLE
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14
Q

what is a muscle fibre?

A

a skeletal muscle cell

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15
Q

what is the arrangement of muscle fibres in skeletal muscle?

A

they are parallel to each other

also bundled by connective tissue

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16
Q

skeletal muscle fibres usually extend the entire length of what?

A

muscle

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17
Q

What joins bone and muscle together?

A

tendons

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18
Q

What are actin and myosin arranged into in myofibrils?

A

sarcomere

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19
Q

What is the length of a sarcomere?

A

one z line to the next one

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20
Q

What does the M line of a sarcomere show?

A

the midpoint of the sarcomere. within the centre of H zone

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21
Q

what does the A band of a sarcomere show?

A

Made up of thick filaments along with portions of thin filaments that overlap in both ends of thick filaments

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22
Q

What does the I band of a sarcomere show?

A

Consists of remaining portion of thin filaments that do not project in A-band

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23
Q

what does the H zone of a sarcomere show?

A

Lighter area within middle of A-band where thin filaments don’t reach

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24
Q

what occurs in the contraction cycle?

A
  1. Energised muscle filament myosin with Ca 2+ presence binds to actin filament (BINDING stage). Removes the troponin
  2. overlapping of both filaments causes release of energy in the form of ADP and Pi ( Power stroke/BENDING)
  3. Available ATP allows the detachment of myosin from actin ( DETACHMENT)
  4. Myosin now energised again
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25
Q

what is the definition of excitation contraction coupling

A

the process whereby the surface action potential results in activation of the contractile structures of the muscle fibre

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26
Q

In skeletal muscle fibres when is Ca 2+ released from the lateral sacs of the sarcoplasmic reticulum?

A

When the surface action potential spreads the transverse tubules

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27
Q

What are transverse tubules? (T-tubules)

A

extensions of the surface membrane that dip into the muscle fibre

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28
Q

Describe the process of skeletal cells contracting and relaxing.

A
  1. Acetylcholine is released by the axon of the motor neuron and crosses the synaptic cleft and binds to receptors on the more end plate
  2. Action potential generated in response to bind of ACh and subsequent end plate potential is propagated across cell surface membrane and down T tubules of muscle cell
  3. Action potential in T tubules stimulate release of Ca 2+ from sarcoplasmic reticulum
  4. Calcium ions released from lateral sacs bind to troponin on actin filaments. Tropomyosin is moved revealing binding sites on actin
  5. Myosin cross bridges attach to actin and bend pulling actin filaments towards centre of sarcomere powered by energy supplied by ATP
  6. Ca2+ is taken up by sarcoplasmic reticulum when there is no local action potential
  7. No more Ca 2+ causes tropomyosin back to its original position blocking actin binding sites. contraction ends
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29
Q

gradation of skeletal muscle tension depends on which two main factors?

A
  1. Number of muscle fibres contracting in the muscle

2. The tension created by each of the contracting muscle fibres

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30
Q

What is motor unit recruitment?

A

The stimulation of more motor units leading to a stronger contraction

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31
Q

what do asynchronous motor units recruitment during submaximal contraction help prevent?

A

muscle fatigue

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32
Q

What are the three main factors which determine the extent of the tension created by contracting muscle fibres?

A

depends on frequency of stimulation and summation of contractions and

length of muscle fibre at the onset of contraction

thickness of muscle fibre

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33
Q

How do you summate twitches which causes stronger contractions of skeletal muscle?

A

repetitive fast stimulation of skeletal muscle

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34
Q

what happens if a muscle fibre is restimulated after it has completely relaxed?

A

second twitch is the same magnitude as the previous one

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35
Q

what happens if a muscle fibre is restimulated before it has completely relaxed?

A

second twitch is added to the first one causing summation

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36
Q

what happens if a muscle fibre is restimulated before it hasn’t relaxed at all?

A

A tetanus forms - maximal sustained contraction

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37
Q

Cardiac muscle can be tetanised true or false?

A

false - long refractory period prevents generation of tetanic contraction

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38
Q

what is a twitch?

A

a single contraction caused by stimulation of a skeletal muscle

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39
Q

How can maximal tetanic contractions be achieved?

A

when the muscle is at its optimal length before the onset of contraction

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40
Q

The resting length of a skeletal muscle is aproximately what?

A

optimal length

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41
Q

what are the two types of skeletal muscle contractions?

A
  1. Isotonic contraction

2. Isometric contraction

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42
Q

What is isotonic contraction used for?

ii. what happens to the muscle tension?

A

(1) body movements
(2) moving objects.
ii. Muscle tension remains constant as the muscle length changes

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43
Q

what is isometric contraction used for?

ii. what happens to the muscle tension?

A

1) supporting objects in fixed positions.
(2) maintaining body posture.
ii. Muscle tension develops at constant muscle length

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44
Q

In both isotonic and isometric contractions how is muscle tension transmitted to the bone?

A

via the elastic components of muscle

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45
Q

when does the velocity of muscle shortening decrease?

A

as the load increases

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46
Q

what are the main differences between the different types of skeletal muscle fibres?

A
  1. the enzymatic pathways for ATP synthesis;
  2. the resistance to fatigue - muscle fibres with greater capacity to synthesise ATP are more resistant to fatigue; and
  3. the activity of myosin ATPase - this determines the speed at which energy is made available for cross bridge cycling i.e. the speed of contraction
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47
Q

What are three main steps involved in metabolic pathways that supply ATP in muscle fibres?

A
  1. Transfer of high energy phosphate from creatine Phosphate to ADP - immediate source for ATP
  2. Oxidative phosphorylation: main source when O2 is present
  3. Glycolysis: main source when O2 is not present
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48
Q

What three main types of skeletal muscle fibres are there?

A
  1. Slow oxidative type I fibres (also known as slow-twitch fibres) are used mainly for prolonged relatively low work aerobic activities e.g. maintenance of posture, walking
  2. Fast oxidative (Type IIa) fibres (also known as intermediate-twitch fibres) use both aerobic and anaerobic metabolism and are useful in prolonged relatively moderate work activities e.g. jogging
  3. Fast glycolytic (Type IIx) fibres (also known as fast-twitch fibers) use anaerobic metabolism and are mainly used for short-term high intensity activities e.g. jumping
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49
Q

What is a reflex?

A

stereotyped response to a specific stimulus

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50
Q

What type of reflex is the stretch reflex?

A

monosynaptic spinal reflex

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51
Q

What type of feedback mechanism is the stretch reflex?

A

negative feedback-resists passive change in muscle length to maintain optimal resting length of muscle

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52
Q

What is the sensory receptor in the stretch reflex?

ii. how is it stimulated?

A

the muscle spindle

ii. muscle stretching

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53
Q

What does stretching the muscle spindle in the stretch reflex cause?

A

increases firing in the afferent neurones

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54
Q

where do the afferent neurones synapse at in the stretch reflex?

A

The afferent neurons synapse in the spinal cord with the alpha motor neurons (efferent limb of the stretch reflex)

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55
Q

what is the result of the stretch reflex?

A

causes contraction of stretched muscle

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56
Q

How can a doctor stimulate the stretch reflex?

A

Tapping the muscle tendon with a rubber hammer - causes muscle to rapidly stretch leading to contraction

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57
Q

What nerve is stimulated by the knee jerk reflex?

ii. what spinal segment is the nerve from?

A

Femoral nerve

ii. L3-4

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58
Q

What nerve is stimulated by the Ankle jerk reflex?

ii. what spinal segment is the nerve from?

A

Tibial nerve

ii.S1-2

59
Q

What nerve is stimulated by the Biceps jerk reflex?

ii. what spinal segment is the nerve from?

A

Musculocutaneous Nerve

ii. C5-6

60
Q

What nerve is stimulated by the Brachioradialis jerk reflex?

ii. what spinal segment is the nerve from?

A

Radial nerve

ii. C5-6

61
Q

What nerve is stimulated by the Triceps jerk reflex?

ii. what spinal segment is the nerve from?

A

Radial nerve

C6-7

62
Q

What is a muscle spindle?

A

collection of specialised muscle fibres

they are the sensory receptors for stretch reflexes

63
Q

What are muscle spindles also known as?

A

intrafusal fibres

64
Q

What are normal muscle fibres (Non muscle spindles) known as?

A

extrafusal fibres

65
Q

where are muscle spindles found in the muscle?

A

within the belly of muscles and run parallel to ordinary muscle fibres

66
Q

What are the muscle spindle’s nerve endings called?

A

annulospiral fibres

67
Q

What happens to the muscle spindle’s discharge when the muscle stretches?

A

it increases

68
Q

What is the name to the efferent neurons which supply muscle spindles?

A

gamma (y) motor neurons

69
Q

What is the role of gamma motor neurons?

A

adjust the level of tension in the muscle spindles to maintain their sensitivity when the muscle shorten during muscle contraction

70
Q

The contraction of intrafusal fibres does not contribute to the overall strength of muscle contraction
true or false?

A

true

71
Q

what are the main causes of Impairment of skeletal muscle function?

A
  1. Intrinsic disease of muscle
  2. Disease of NMJ
  3. Disease of lower motor neurons
    which supply the muscle

4.Disruption of input to motor
nerves (e.g. upper motor neuron disease

72
Q

What are the main causes of intrinsic muscle disease?

A
  1. genetically determined myopathies
  2. Acquired myopathies

e.g. Inflammatory myopathies e.g. polymyositis, inclusion body myositis
Non-Inflammatory myopathies e.g. fibromyalgia

Endocrine mypoathies e.g. Cushing syndrome, thyroid disease

Toxic myopathies e.g. alcohol, statins

73
Q

What are the three main types of joints in the body?

A
  1. synovial
  2. Fibrous
  3. Cartilaginous
74
Q

What is the function of fibrous joints?

A

doesn’t allow for any movement

75
Q

Give an example of a fibrous joint

A

Bones of skull in adults

76
Q

How are bones joined together in fibrous joints?

A

Fibrous tissue

77
Q

What is the function of cartilaginous joints?

A

Allows limited movement

78
Q

Give examples of cartilaginous joints.

A

Intervertebral Discs

Pubic symphsis

Part of the sacroiliac joints

Costochondral joints

79
Q

How are bones joined together via cartilaginous joints?

A

Via cartilage

80
Q

what is a synovial joint?

A

Bones separated by a cavity (containing synovial fluid) and united by a fibrous capsule (and other extra-articular structures e.g. ligaments, tendons, and bursae)

81
Q

what is a synovial joint?

A

Bones separated by a cavity (containing synovial fluid) and united by a fibrous capsule (and other extra-articular structures e.g. ligaments, tendons, and bursae)

82
Q

What is the inner aspect of the fibrous capsule lined with?

A

Synovial membrane

83
Q

what is the synovial membrane?

ii. what cells does this contain?

A

vascular connective tissue with capillary networks and lymphatics

ii. contains synovial cells (fibroblasts)

84
Q

what do fibroblasts produce?

A

produces the synovial fluid

85
Q

What are the articular surfaces of synovial joints covered in ?

A

Cartilage

86
Q

what are the two types of synovial joints?

A

simple

compound

87
Q

what are the differences between the two main subtypes of synovial joints?

A

simple synovial joints have one pair of articular surfaces e.g. metacarpophalangeal joints

compound synovial joints have more than one pair of articular surfaces e.g. elbow joints

88
Q

What is the role of joints in purposeful motion?

A 
Stress distribution
(note that the greatest share of loading energy is taken up within the muscles and tendons crossing each joint)

Confer stability
Shape of the articular component e.g. the hip joint
Ligaments provide a second major stabilising influence
Synovial fluid acts as an adhesive seal that freely permits sliding motion between cartilaginous surfaces

Joint lubrication provided by
Cartilage interstitial fluid
Synovium - derived hyaluronic acid (mucin) - a polymer of disaccharides
Synovium-derived lubrcin - a glycoprotein

89
Q

what is the role of synovial fluid?

A

Lubricates Joint

Facilitates joint movements - reduces friction

Helps minimise wear-and-tear of joints through efficient lubrication

Aids in the nutrition of articular cartilage

Supplies the chondrocytes (cartilage cells) with O2 and nutrients and remove CO2 and waste products

90
Q

Why is the synovial fluid described as not being static in the synovial joint?

A

as it is constantly being absorbed by the synovial membrane and also being produced

91
Q

Why has synovial fluid got high viscosity?

A

due to the presence of hyaluronic acid (mucin) produced by the synovial cells

92
Q

what cells does the synovial fluid contain?

A

contains few cells (mainly mononuclear leucocytes

93
Q

what are the two main properties of synovial fluid which changes during movement?

A

elasticity

viscosity

94
Q

What happens to the two main properties of synovial fluid during rapid movement?

A

elasticity increases

viscosity decreases

95
Q

what is the normal colour of synovial fluid?

A

clear and colourless

96
Q

What is the normal WBC count in synovial fluid?

A

<200 WBC/mm3

of which polymorphs are usually <25/mm3

97
Q

What is the colour of synovial fluid in traumatic spinal tap and haemorrhagic arthiritis?

A

Red

98
Q

What is the WBC in synovial fluid in inflammatory synovial fluid?

A

2000-75000

99
Q

What is the WBC in synovial fluid in septic synovial fluid?

A

> 100,000

polymorph usually >75

100
Q

what is the colour of synovial fluid in inflammatory synovial fluid?

A

straw coloured

101
Q

what is the function of articular cartilage in a synovial joint?

A

Provides a low friction lubricated gliding surface. This helps prevent wear-and-tear of joints

Distributes contact pressure to subchodral bone

The composition of the cartilage ECM and the interaction between the fluid and solid phase of the cartilage plays a significant role in determining the mechanical properties of cartilage

102
Q

What are the layers of articular cartilage from superficial to deep?

A
  1. articular surface
  2. superficial zone (10-20%)
  3. Mid zone (40-60%)
  4. deep zone (30%)
  5. calcified zone

Zones differ in: organization of collagen fibres and relative content of cartilage components

103
Q

What is the articular cartilage mainly made out of?

A

Hyaline

104
Q

What is the Extracellular matrix of the articular cartilage consist of?

A

water (70%),

collagen (20%) -mainly type II contributes most to the elastic behaviour of cartilage,

proteoglycans (10%)

105
Q

what is the role of water in the ECM of articular cartilage?

A

Maintain the resiliency of the tissue and contribute to the nutrition and lubrication system

106
Q

what is the role of collagen in the ECM of articular cartilage?

A

Provides tensile stiffness and strength

107
Q

what happens to water and collagen as people get older?

A

levels decrease in the ECM

108
Q

what is the role of Proteoglycan

in the ECM of articular cartilage?

A

Responsible for the compressive properties associated with load bearing

109
Q

where is proteoglycan mainly found in the ECM of articular cartilage?

A

the middle and deep zone

110
Q

what is the proteoglycan mainly made out of?

A

glycosaminoglycan e.g. chondroitin sulphate

111
Q

what is the ECM is synthesized, organised, degraded and maintained by?

A

chondrocytes

112
Q

In normal joints which is faster, ECM synthesis or ECM degradation?

A

ECM synthesis

113
Q

what do chondrocytes secrete to break down ECM?

A

Metalloproteinase proteolytic enzymes e.g. collagenase and stromelysin

114
Q

What are the catabolic factors of cartilage matrix turnover?

A

Stimulate proteolytic enzymes and inhibit proteoglycan synthesis

e.g.
Tumour necrosis factor (TNF)-
Interleukin (IL)-1

115
Q

What are the anabolic factors of cartilage matrix turnover?

A

Stimulate proteoglycan synthesis and counteract effects of IL-1

e.g.
Tumour growth factor (TGF)-β
Insulin-like growth factor (IGF)-1

116
Q

What are the two main signs of cartilage degradation?

A
  1. increased levels of Serum and synovial keratin sulphate

Level increases with age and patients with osteoarthritis

  1. increased levels of Type II collagen in synovial fluid

Useful in evaluating cartilage erosion e.g. in osteoarthritis and rheumatoid arthritis

117
Q

what is pain?

A

When she doesn’t message you back

or

” An unpleasant sensory and emotional experience, associated with actual tissue damage or described in terms of such damage”

118
Q

What are the 4 main physiological processes of pain?

A

Transduction: translation of noxious stimulus into electrical activity at the peripheral nociceptor

Transmission: propagation of pain signal as nerve impulses through the nervous system

Modulation: modification/hindering of pain transmission in the nervous system e.g. by inhibitory neurotransmitters like endogenous opioids

Perception: Conscious experience of pain. Causes physiological and behavioural responses

119
Q

What are nociceptors?

A

Nociceptors are specific primary sensory afferent neurones normally activated by intense noxious stimuli (e.g. mechanical, thermal or chemical)

120
Q

What type of order neurone is a Nociceptor?

A

first order neurone - relay information to second order neurones in the CNS by chemical synaptic transmission

121
Q

In which system do second order neurones ascend the spinal cord?

A

the anterolateral system

terminates at thalamus

122
Q

what does the anterolateral system consist of?

A

The spinothalamic tract (STT): Involved in pain perception (location, intensity)

The spinoreticular tract (SRT): Involved in autonomic responses to pain, arousal, emotional responses, fear of pain

123
Q

What happens at the the thalamus?

A

sensory information is relayed (third order neurones) to the primary sensory cortex

124
Q

what are the two main types of nociceptors?

A

A-fibres

C-fibres

125
Q

What type of nociceptor is the A-fibre?

ii. what stimuli do they respond to?

A

Mechanical/thermal nociceptors that are thinly myelinated . respond fast to pain

ii. mechanical and thermal stimuli

126
Q

What type of nociceptor is the C-fibre?

what stimuli do they respond to?

A

nociceptors that are unmyelinated. respond slowly to pain

ii. all noxious stimuli -polymodal

127
Q

What are three main types of pain classified by mechanism?

A
  1. inflammatory
  2. nociceptive
  3. pathological
128
Q

what is nociceptive pain?

ii. what provokes it?

A

normal response to injury of tissues by noxious (damaging) stimuli

ii. only intense stimulation of nociceptors

129
Q

Nociceptive pain adaptive true or false?

A

true

130
Q

what is inflammatory pain?

ii. what provokes it?

A

activation of the immune system by tissue injury or infection

ii. variety of mediators released at the site of inflammation by leucocytes, vascular endothelium and tissue resident mast cells

131
Q

what does inflammatory pain cause?

A

discourages physical contact and movement

132
Q

inflammatory pain adaptive true or false?

A

true

133
Q

what are the two main subtypes of pathological pain?

A

Neuropathic and dysfunctional

134
Q

what is neuropathic pain caused by?

A

damage to neural tissue

135
Q

Give some examples of neuropathic pain.

A 
compression neuropathies, 
peripheral neuropathies, 
central pain (following stroke or spinal injury), 
postherpetic neuralgia, 
trigeminal neuralgia, 
phantom limb

feels like burning/pins and needles

136
Q

What is dysfunctional pain?

A

no identifiable damage or inflammation

137
Q

Give some examples of dysfunctional pain.

A

fibromyalgia,
irritable bowel syndrome,
tension headache,
temporomandibular joint disease, interstitial cystitis

138
Q

Pathological pain is adaptive true or false?

A

false- it is maladaptive

139
Q

What is refered pain caused by?

A

convergence of nociceptive visceral and skin afferents upon the same spinothalamic neurons at the same spinal level

140
Q

What is the principal role of the ACL?

A

To prevent abnormal internal rotation of the tibia

141
Q

What is the principal role of the posterior cruciate ligament (PCL)?

A

Prevents hyperextension and anterior translation of the femur

142
Q

What is the principal role of the medial cruciate ligament (MCL)?

A

Resists valgus force

143
Q

What is the Principal role of the Lateral cruciate ligament (LCL)?

A

Resists varus force and abnormal external rotation of the tibia

MSK (7 decks)

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