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1
Q

primary cartilaginous joints consist of what?
examples?

secondary cartilaginous joints consist of what?
examples:

A

Primary: HYALINE
- in SKULL between SPHENOID and OCCIPITAL Bones
- in BONE between DIAPHYSIS and EPIPHYSIS
- between 1ST RIB and STERNUM

  1. Secondary: FIBROCARTILAGE with HYALINE at edges
    - between INTERVERTEBRAL DISCS
    - MANUBRIOSTERNAL JOINT
    - PUBIC SYMPHYSIS
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2
Q
  • Gliding/Planar joints movement:
  • Hinge joints movement:
  • Pivot joints movement:
  • Ellipsoid/Condyloid joints movement:
  • Saddle/Sellar joints movement:
  • Ball and Socket joints movement:
A
  • Gliding/Planar joints movement:
    VERY SMALL AMOUNT MOVEMENT ie. Sacroiliac
  • Hinge joints movement:
    SINGLE PLANE ie elbow and knee
  • Pivot joints movement:
    ROTATION ie proximal radioulnar, axis/atlas of spine
  • Ellipsoid/Condyloid joints movement:
    2 PLANES ie radiocarpal joint (wrist), metatarsophalangeal
  • Saddle/Sellar joints movement:
    CIRCUMDUCTION (no rotation) ie thumb
  • Ball and Socket joints movement:
    ALL MOVEMENTS, ROTATION, CIRCUMDUCTION
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3
Q

steps of Endochondral Ossification

A
  1. Chondrocytes increase in number while Matric Calcifies around it
  2. Chondrocytes die and leave behind CALCIFIED CARTILAGE Shell
  3. BLOOD VESSELS come into the PERICHONDRIUM. differentiation of OSTEOBLASTS will form PERIOSTEUM
  4. BLOOD VESSELS and FIBROBLASTS come into the CALCIFIED CARTILAGE. OSTEBOBLASTS cause CARTILAGE to be REPLACED BY TRABECULAR BONE
    - PRIMARY OSSIFICATION CENTRE
  5. wave of Ossification spreads and OSTEOCLASTS REABSORB T BONE from the centre to leave MARROW CAVITY
  6. Periosteum bone grows inwards and becomes COMPACT BONE
  7. BLOOD and OSTEOBLASTS MIGRATE to the EPIPHYSIS to form bone
    - SECONDARY OSSIFICATION
  8. Trabecular bone in epiphyses leaves 2 areas of Cartilage: ARTICULAR CARTILAGE and EPIPHYSEAL GROWTH PLATE
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4
Q

1.Osteoblasts have high levels of what?

  1. what do Osteoblasts secrete?
  2. what is the origin of osteoblast / what cell is it differentiated from?
  3. which Transcription Factors are required to form osteoblast?
  4. which other cells may form instead?
  5. What Inhibits Osteoblasts in the case of Excessive Bone Formation?
A
  1. ALKALINE PHOSPHATASE
    ER, Golgi, Secretory Vesicles
  2. OSTEOID - UNCALCIFIED BONE MATRIX
    as well as OSTEOCALCIN (Bone Formation Marker)
    and TYPE 1 COLLAGEN
    GROWTH FACTORS
    PROSTAGLANDINS
  3. MESENCHYMAL STROMA CELLs
  4. SOX9
    RUNX2
    OSX
  5. Sox9 can also form ADIPOCYTE or commonly CHONDROCYTE
  6. SCLEROSTIN - INHIBITS OSTEOBLASTS
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5
Q
  1. Skeleton makes up how much of body weight
  2. how much of the body’s calcium is in the bones
A

17%

  1. 98% of calcium as hydroxyapatite
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6
Q

what is the major structural protein in the body that provides strength and flexibility

A

TYPE 1 COLLAGEN

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7
Q
  1. how are Osteoclasts Nucleus?
  2. Osteoclasts have a Ruffled Border for Secretion of what?
  3. Express high levels of what to generate this? and otherwise?
  4. what do Osteocyte Precursors express and how are they activated?
  5. Activation of this receptor causes activation of what?
  6. what is used to Inhibit Bone Resorption when excessive
  7. what can be used to Increase Osteoclast Rectuitment?
  8. What is the use for Cl- Channels in Osteoclasts
  9. Enzyme/protease secreted from Osteoclasts for degradation of Type 1 Collagen?
  10. Dysfunctional Osteoclasts can cause what disease?
  11. where might the Mutations be in the Osteoclasts in case of this disease?
A
  1. MULTINUCLEATE
  2. RUFFLED BORDER: H+ ENZYME SECRETION
    and proteolytic enzymes
  3. High levels of CARBONIC ANHYDRASE
    for H+ GENERATATION

and TRAcP (TARTRATE-RESISTANT ACID PHOSPHATASE) which acts as a marker for resorption

  1. RANK RECEPTOR
    - activated by RANK LIGAND (RANKL) on OSTEOBLAST/OSTEOCYTE BINDING
  2. RANK Activation ACTIVATES NFkB TRANSCRIPTION FACTOR (NUCLEAR FACTOR kB)
    -> differentiation into Mature Osteoclast
  3. OPG (OSTEOPROTEGERIN)
    - BINDS RANK L on OSTEOBLAST therefore can’t activate osteocyte precursor
  4. CYTOKINES INCREASE Osteoclast RECRUITMENT
  5. secretes Cl- for HCL FORMATION
    - ACIDIC ENVIRONMENT to DISSOLVE HYDROXYAPATITE
  6. CATHEPSIN K enzyme degrades TYPE 1 COLLAGEN
  7. OSTEOPETROSIS (INCREASES BONE MASS)
  8. CARBONIC ANHYDRASE MUTATION
    PROTON PUMP MUTATION
    CL- CHANNEL MUTATION
    CATHEPSIN K MUTATION
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8
Q
  • Bone Formation Markers (Osteoblasts):
  • Bone Resorption Markers (Osteoclasts):
A
  • Bone formation markers:
    OSTEOCALCIN
    ALKALINE PHOSPHATASE
    Collagen TELOPEPTIDES
  • Bone Resorption markers:
    PYRIDINIUM CROSS-LINKS (not resorbed)
    TRAcP (TARTRATE RESISTANT ACID PHOSPHATASE)
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9
Q
  1. how often is the Skeleton renewed?
  2. How long does the Bone Remodelling cycle take?
  3. how long is Resorption phase with Osteoclasts?
  4. How long is the Reversal phase with Osteoblasts?
A
  1. every 7-10 years
  2. 4-6 MONTHS
  3. Resorption: 10 DAYS
  4. Reversal phase: 3 MONTHS
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10
Q

what do Osteocytes produce?

A
  • RANK L (osteoclast activation)
  • SCLEROSTIN (inhibits osteoblast activation when excessive)
  • NITRIC OXIDE / NO (bone resorption)
  • PROSTAGLANDINS
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11
Q
  • what is Osteoporosis?
  • what is Paget’s Disease?
  • what can cause High Bone Mass Disease?
A
  • Osteoporosis: increased bone RESORPTION so low bone density
  • Paget’s : OVERACTIVE OSTEOCLASTS so low bone mass
  • LOSS of SCLEROSTIN -> High bone mass from Osteoblasts
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12
Q

What may inhibit the production of some interleukins like IL6 (cytokine)

A

SEX STEROIDS

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13
Q

Differences between Tendons and Ligaments:

A

Tendon:
- Bone to Muscle
- PARALLEL bundles
- MORE COMPACT

tendon forces usually uniaxial

Ligament:
- ELASTIC
- CROSS-CONNECTING, IRREGULAR BUNDLES (NOT parallel)
in ECM: MORE PROTEOGLYCANS, MORE ELASTIN, MORE COLLAGEN TYPE I
MORE CARTILAGINOUS PROTEINS ie. AGGRECAN, CARTILAGE TYPE II

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14
Q
  1. what are Axial Tendons derived from?
  2. what are Head Tendons derived from?
  3. what are Limb Tendons derived from?
  4. the initiation of which tendons is Muscle Dependent
A
  1. SOMITES -> AXIAL TENDONS
  2. NEURAL CREST CELLS -> HEAD TENDONS
  3. LIMB LATERAL PLATE -> LIMB TENDONS
  4. AXIAL TENDONS initiation is MUSCLE DEPENDENT but later on independent
    (Head and limb initiation is muscle independent but further development is Dependent)
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15
Q
  1. what is the earliest known tendon/ligament marker?
  2. which factors support Tenocyte Differentiation to form Tendons
  3. what regulates downstream Tendon-related Genes during development?
A
  1. SCX (expression decreases after birth)
  2. EGR1 and MKX (persist after birth)
  3. SCX
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16
Q
  1. what is meant by Viscoelastic property Creep?
  2. what is meant by Viscoelastic property Hysteresis?
  3. what is meant by Viscoelastic property Stress-Relaxation?
  4. in a Stress-Strain curve what is the Toe Region?
  5. above what strain is there Failure
A
  1. Creep: DEFORMATION OVER TIME - Time dependent deformation under constant load
  2. UNLOADING curve is different to the LOADING curve
  3. ability to REDUCE STRESS OVER TIME. time dependent DECREASE IN LOAD REQUIRED to MAINTAIN MATERIAL at Constant Strain
  4. < 2%. crimpled fibres STRAIGHTEN
  5. 4-8%
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17
Q
  1. how is Collagen made and by which Genes
  2. how many different collagen types are there?
  3. collagen triple-helix is made up of which monomers?
A
  1. COL1AL -> ALPHA 1 chain
    COL1A2 -> ALPHA 2 chain

2x alpha 1 chains and 1x Alpha 2 chain combine to form TRIPLE HELICLE PROCOLLAGEN
- SECRETED into ECM
- CLEAVAGE of N- and C- TERMINAL PROPEPTIDES
- PYRIDINIUM CROSS LINKING

  1. 28 TYPES
  2. AMINO ACID repeats wound into triple helix and aligned in elongated fibrils
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18
Q
  1. important roles of Collagen?
  2. where is Type 1 found?
  3. where is Type 2 found?
  4. where is Type 3 found?
A
  1. main role: CONNECT BONES TOGETHER
    place for BONE FORMATION
    TENSILE STRENGTH,
    CHEMOTAXIS,
    CELL ADHESION and MIGRATION,
    TISSUE REMODELLING and GROWTH
    WOUND HEALING
    Maintaining TISSUE STRUCTURE and FUNCTION
  2. TYPE 1: BONE, SKIN
  3. TYPE 2: CARTILAGE
  4. TYPE 3: Extensible Connective Tissue ie SKIN, LUNG,
    VASCULAR SYSTEM
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19
Q
  1. Scurvy is due to a lack of what?
  2. Symptoms in Scurvy:
  3. what can you get from Lack of TYPE 1 collagen (mutation)?
  4. what is caused by Mutations in TYPE 5 Collagen
A
  1. Lack of VITAMIN C
  2. BONES BREAK EASILY,
    FRAGILE CAPILLARIES
    BLEEDING,
    BRUISING,
    INTERNAL HEMORRHAGE,
    TEETH LOOSEN
  3. type 1: OSTEOGENESIS IMPERFECTA
  4. type 5: EHLERS DANLOS SYNDROME
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20
Q
  1. what Increase in Tendon Injury?
  2. what do these contribute to?
  3. what do they interact with and why?
A
  1. PROTEOGLYCANS
  2. STRUCTURAL INTEGRITY
  3. Interact with COLLAGEN
    for FIBRILLOGENESIS and ORGANISATION of collagen
    (for joint stability)
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21
Q

Elastic Fibres regulate the activity of which Growth Factor?

other functions?

  1. Elastin is mainly found in IFM region co-localised with what?
    and associated with what
A
  • TGF BETA family
  • REGULATE CELL FUNCTION
  1. co-localised with FIBRILLIN 1 and 2
    associated with COLLAGEN TYPE 6
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22
Q

which disease is caused by a Mutation in the FNB1 Gene

A

MARFAN SYNDROME

  • DISORDER OF CONNECTIVE TISSUE
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23
Q

Tendons and Ligaments are mostly made up of which 3 elements

A
  • TYPE 1 COLLAGEN
  • PROTEOGLYCANS
  • ELASTIN (can stretch 150% of original length)

(ligaments have more of each)

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24
Q
  1. why do Proteoglycans such as Aggrecan have large Hydrodynamic volume and swelling?
  2. what is this swelling pressure counteracted/ held together by?
  3. together these enable joints to do what?
A
  1. have LARGE OSMOTIC AFFECT
  • Core Protein is covalently linked to at least one GLYCOSAMINOGLYCAN (GAG) which carry NEGATIVE CHARGES
    ->ATTRACT CATIONS ie NA+
    ->WATER FOLLOWS

water held in matrix
- LARGE HYDRODYNAMIC VOLUME -> SWELLING

  1. swelling is held together by the Resistance of COLLAGEN FIBRES in cartilage
  2. enable joints to RESIST MECHANICAL LOAD / COMPRESSIVE FORCE
    while maintaining HIGH TENSILE STRENGTH
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25
Q
  1. which cartilage type Lacks a True Perichondrium?
  2. which cartilage type is Avascular and Aneural
  3. Zones in Articular cartilage:
    what is the Tide Mark?
    how do orientation of Collagen Fibres change?
A
  1. FIBROCARTILAGE
    (TMJ, Menisci, Intervertebral Discs, Pubic symphysis)
  2. HYALINE / ARTICULAR is AVASCULAR and ANEURAL
  3. ZONE 1: TANGENITAL
    ZONE 2: TRANSITIONAL
    ZONE 3: RADIAL
    ZONE 4: CALCIFIED CARTILAGE

TIDE MARK: Separates CALCIFIED CARTILAGE

COLLAGEN Fibres in zone 1 are PARALLEL
in zone 4 they are STOOD ON THEIR ENDS (more resistant)

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26
Q
  1. what are the 3 components of Synovial Fluid?
  2. what is Viscosity?
  3. what is Shear Rate
  4. what is the equation for Viscosity?
  5. which component provides Viscosity to synovial fluid in fluid-film lubrication and why?
  6. what do we get as shear rate increases
A
  1. LUBRICIN - PROTEOGLYCAN
    encoded by prg4 gene
    secreted by articular cartilage and synovium

HYALURONAN (HA) / HYALURONIC ACID - GAG
composed of glucuronic acid and n-acetylglucosamines
synthesised at plasma membrane

PHOSPHOLIPIDS
ie Sphingomyelin, Phosphatidylcholine, Phosphatidylethanolamine
prove HYDROPHOBICITY to articular surface (LUBRICATION)

  1. VISCOSITY is the INTERNAL FRICTION of a FLUID
  2. SHEAR RATE = FLUID SPEED COMPARED TO SURFACE that it is sliding from
  3. VISCOSITY = SHEAR STRESS / SHEAR RATE

decrease viscosity, increase shear rate

  1. HYALURONAN (HA) provides VISCOSITY to synovial fluid due to its HIGH MOLECULAR WEIGHT and CONCENTRATION
  2. INCREASE SHEAR RATE -> SHEAR THINNING derived from HA alignment molecule (= VISCOSITY DECREASING)
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27
Q

in Fluid Film Lubrication what is the..

  1. Squeeze model?
  2. Boosted Model?
  3. Electrohydrodynamic Model?
A
  1. SQUEEZE: as two surfaces are squeezed together, FLUID SQUEEZED OUT OF GAPS
    - GENERATING HYDROSTATIC PRESSURE
  2. BOOSTED: WATER MOVES INTO CARTILAGE
    - INCREASE HYALURONIC ACID CONC. in FLUID-FILM
  3. ELECTROHYDRODYNAMIC:
    MOVING. DEFORMATION OF SURFACE
    - TRAPS PRESSURIZED FLUID
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28
Q

what is meant by Lambda Ratio

A

MINIMUM FILM THICKNESS (hmin) in relation to the composite surface Roughness (Ra1, Ra2)

Boundary lubrication: <1
Fluid Film lubrication: >3
mixed lubrication: 1 < and < 3

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29
Q
  1. what is an early indicator of Osteoarthiritis?
  2. what is Aggrecan cleaved by
  3. what are released in Aggrecan Cleavage causing Swelling
A
  1. OA: PROSTEOGLYCAN LOSS
  2. AGGRECAN CLEAVAGE:
    METZINCINS - MMPs and ADAMTSs
  3. GLYCOSAMINOGLYCANS / SUGARS RELEASED and escape
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30
Q

what are the steps in the formation of articulation (2 bones articulating at joint)?

  • what Cytokine do Chondrocytes release to induce Cavitation?
  1. which GDF5 pathway forms Synovial Lining and Ligaments?
  2. which GDF5 pathway forms Articular Cartilage?
  3. which GDF5 pathway forms Growth Plate Cartilage?
A
  1. MESENCHYMAL CELLS CONDENSE
  2. Joint Site Determination
  3. Mesenchyme cells gather to FORM INTERZONE and DIFFERENTIATE INTO CHONDROCYTES
  4. CAVITATION
  5. Morphogenesis
  6. Synovial Joint Formation
  • GDF5 INDUCES CAVITATION
  1. ANTI-CHONDROGENIC -> WNT. 9b -> SYNOVIAL LINING & LIGAMENTS
  2. ANTI-CHONDROGENIC -> NOTCH -> ARTICUALR CARTILAGE
  3. SOXs -> CHONDROGENIC -> Erg, TGF-Beta -> GROWTH PLATE CARTILAGE
31
Q
  1. in endochondral ossification what differentiate to form chondrocytes?
  2. chondrocytes will form which Collagen type?
  3. Hypertrophic Chondrocytes (larger) form which Collagen type?
  4. what is needed for Secondary Ossification Centre to form?
  5. Column Formation in the Growth Plate is stimulated by which Chemokine?
  6. what does it activate in order for the column formation?
  7. what does the activation of this cause for Hypertrophic Chondrocytes?
  8. what does the Apoptosis of Hypertrophic Chondrocytes allow for?
A
  1. MESENCHYMAL cells (CONDENSE & DIFFERENTIATE)
  2. Chondrocytes -> COLLAGEN II
  3. Hypertrophic chondrocytes -> COLLGEN X
  4. VASCULAR INVASION into epiphysis-> SECONDARY OSSIFICATION CENTRE
  5. INDIAN HEDGEHOG (IHH) for column formation in growth plates
  6. PARATHYROID HORMONE RELATED PROTEIN (PTHrP) is activated
  7. HYPERTROPHIC CHONDROCYTES SWITCH FROM COLLAGEN II TO COLLAGEN X FORMATION
  8. APOPTOSIS of HYPERTROPHIC CHONDROCYTES
    -> OSTEOBLASTS come in to form PRIMARY SPONGIOSA
    (and favours matrix mineralisation and blood vessel invasion)
32
Q
  1. which bones come from Intramembranous Ossification?
  2. what is different about it?
A
  1. SKULL, CLAVICLE
  2. BONE FORMED DIRECTLY FROM MESENCHYME
    - NO CHONDROCYTES
    - NO CARTILAGE INTERMEDIARY
    - NO SOX Transcription factors
33
Q

which Bone Cells are Motile

A

OSTEOCLASTS

34
Q

what is the Bregma?

what is the Lambda?

what is a Pedicle?

what is a Lamina

A
  1. Bregma: where Coronal and Sagittal sutures meet
  2. Lambda: where Sagittal and Lambdoid Sutures meet
  3. Pedicle: between vertebral body and transverse process
  4. Lamina: between transverse process and spinous process (in vertebra)
35
Q
  1. which face muscles Elevate the jaw?
  2. which face muscles Protrude the jaw (stick out)?
  3. which face muscles Retract the jaw (bring in)
  4. which is to open the jaw?
A
  1. ELEVATE:
    TEMPORALIS
    MASSETER
    MEDIAL PTERYGOID
  2. PROTRUSION:
    MASSETER
    MEDIAL PTERYGOID
    LATERAL PTERYGOID
  3. RETRACT:
    TEMPORALIS
  4. OPEN JAW:
    LATERAL PTERYGOID (open and protrude)
    & Infrahyoid & Digastric
36
Q
  1. 1st Pharyngeal Arch gives rise to which action muscles?
  2. 2nd Pharyngeal Arch gives rise to which action muscles?
A
  1. 1ST PA: MUSCLES OF MASTICATION
  2. 2ND PA: MUSCLES OF FACIAL EXPRESSION
37
Q

What are the variations / different features of each Vertebrae:
- Cervical:
- Thoracic:
- Lumbar:

A

CERVICAL:
- BIFID SPINOUS PROCESS
- Transverse process split into ANTERIOR TUBERCLE and POSTERIOR TUBERCLE with a FORAMEN TRANSVERARIUM for the passage of Vertebral Arteries
- LARGE VERTEBRAL FORAMEN (spinal cord thickens)
- More WHITE MATTER than grey
- clear line in white matter for FASICULUS GRACILIS and FASCICULUS CUTANEOUS (above T6)
- ATLAS (C1) and AXIS (C2) have NO BODY
- ATLAS: ANTERIOR ARCH and POSTERIOR ARCH and
foramen transversarium
- AXIS : DENS PROCESS and bifid spinous process

  • ZYGOPAPHOPHYSEAL JOINT is SLOPED

THORACIC:
- LONG, INFERIORLY POINTING SPINOUS PROCESS
- COSTOVERTEBRAL and COSTOTRANSVERSE JOINTS

  • ZYGOPAPHOPHYSEAL JOINT is VERTICAL so no movement

LUMBAR:
- LARGE BODY
- SQUARE, STOUT SPINOUS PROCESS
- MORE GREY MATTER and little white matter

  • ZYGOPAPHOPHYSEAL JOINT is CURVED and WRAPPED for lots of FLEXION & EXTENSION
38
Q
  1. what is the Ligamentum Nuchae for?
  2. what is the Ligamentum Flavum for?
  3. what is the Anterior Longitudinal Ligament for?
  4. what are Supraspinous and Interspinous ligaments for?
A
  1. LIGAMENTUM NUCHAE:
    from spine to back of skull
    HOLDS SKULL UPRIGHT, FACING FORWARD
  2. LIGAMENTUM FLAVUM:
    - YELLOW
    - connects the VERTEBRA LAMINA TOGETHER
    (lamina is between transverse and spinous process)
  3. ANTERIOR LONGITUDINAL LIGAMENT:
    - PREVENTS OVEREXTENSION of BACK
  4. SUPRASPINOUS and INTERSPINOUS LIGAMENTS
    - PREVENT OVERFLEXION of BACK
39
Q
  1. what type of joint are Intervertebral Discs
  2. what does each part do?
A

SECONDARY CARTILAGINOUS
- FIBROCARTILAGE

  1. ANNULUS FIBROSIS - LIMITS EXCESSIVE MOVEMENT and TWITCING

NUCLEUS PULPOSIS - GELATINOUS CORE for SHCOK ABSORPTION and WEIGHT DISTRIBUTION

40
Q
  1. where are the Primary Ossification Centres in Vertebra?
  2. where are the Secondary Ossification Centres in Vertebra?
A
  1. PRIMARY ossification centre: IN PEDICLES
  2. SECONDARY ossification centre: at the TIPS OF TRANSVERSE & SPINOUS PROCESSES
41
Q
  1. where is the Coracoid Process?
  2. where is the Coranoid Process?
  3. Posteriorly what divides the Scapula and into what?
  4. what does the Head of the Humerus articulate with?
  5. what Pierces the Glenohumeral Joint Capsule to enter it?
A
  1. CORACOID PROCESS of SCAPULA
  2. CORANOID PROCESS of ULNA - articulates with CORANOID FOSSA of HUMERUS
  3. SPINE OF THE SCAPULA
    - SUPRASPINOUS FOSSA
    - INFRASPINOUS FOSSA
  4. Humerus -> GLENOID FOSSA of SCAPULA
  5. TENDON OF LONG HEAD of BICEPS BRACHII Pierces the GLENOHUMERAL JOINT CAPSULE
42
Q
  1. what is the first 120 degrees of Arm Abduction due to?
  2. what is the last 60 degrees of Arm Abduction due to?
A
  1. 120 DEGREES: HUMERUS ROTATING IN GLENOID FOSSA
  2. LAST 60 DEGREES: ROTATION OF SCAPULA
43
Q

what are the Rotator Cuff Muscles and what do they each do?

A

SITS

  • SUPRASPINATUS
    Initial 15 degrees of ABDUCTION
  • INFRASPINATUS
    LATERAL ROTATION
  • TERES MINOR
    LATERAL ROTATION
  • SUBSCAPULARIS (anterior)
    MEDIAL ROTATION
44
Q

Brachial Plexus Cords (Lateral, Posterior, Medial) are named in relation to what?

A

AXILLARY ARTERY

45
Q
  1. which nerve supplies the Anterior Upper Arm Muscles : Biceps Brachii, Brachialis and Coracobrachialis ?
  2. which nerve supplies the Posterior Upper Arm Muscles : Triceps Brachii ?
A
  1. MUSCULOCUTANEOUS nerve = BBC
    (Biceps, Brachialis, Coracobrachialis)

(C5,C6,C7)

46
Q
  1. which Articulations allow for Flexion and Extension of the Forearm?
    and which ligaments support it?
  2. which Articulation allows for Pronation and Supination of the forearm?
    and which ligaments support it?
  3. what holds the bones together for Pronation and Supination
  4. which muscles are for Supination?
  5. where does the Pronator Teres attach to and from?
  6. which Pronator muscle is Deep and which is Superficial?
A
  1. (humerus) TROCHLEAR with ULNA (trochlear notch)
    and (humerus) CAPITULUM with RADIUS
  • ULNA COLLATERAL LIGAMENT and RADIAL COLLATERAL LIGAMENT
  1. RADIUS and ULNA (Radial notch)
  • ANNULAR LIGAMENT OF RADIUS secures in place
  1. ARTICULAR DISC at the DISTAL RADIO-ULNAR JOINT
    and
    INTEROSSEUS MEMBRANE
  2. SUPINATION : BICEPS BRACHII and SUPINATOR
  3. PRONATOR TERES: from MEDIAL EPICONDYLE (HUMERUS) —> LATERAL SURFACE of RADIUS
  4. DEEP: PRONATOR QUADRATUS
    SUPERFICIAL: PRONATOR TERES
47
Q
  1. How many Bones in the Hand?
    how many of each?
  2. How many Bones in the Feet?
    how many of each?
  3. Name the Tarsals
A
  1. 27 HAND BONES
    - 8 CARPAL (SLTPHCTT)
    - 5 METACARPALS
    - 14 PHALANGES
  2. 26 FOOT BONES
    - 7 TARSAL
    - 5 METATARSALS
    - 14 PHALANGES
  3. CALCANEUS
    TALUS
    NAVICULAR
    CUBOID
    LATERAL CUNEIFORM, INTERMEDIATE CUNEIFORM, MEDIAL CUNEIFORM
48
Q
  1. tendons of which Muscles pass through the Carpal Tunnel?
  2. which Nerve passes through Carpal Tunnel?
  3. name of the fibrous connective tissue band that forms the Anterior Roof of the carpal tunnel?
  4. Carpal Tunnel Syndrome causes Weakness and Loss of which muscles?
A
  1. tendons of FLEXOR DIGITORUM PROFUNDUS, FLEXOR POLLICUS LONGUS, FLEXOR DIGITORUM SUPERFICIALIS
  2. MEDIAN NERVE
  3. FLEXOR RETINACULUM
  4. THENAR MUSCLES (Thumb)
49
Q
  1. tendon of which forms the Lateral border of the Anatomical Snuffbox?
  2. tendon of which muscle forms the Medial Border of the Anatomical Snuffbox?
A
  1. LATERAL BORDER:
    EXTENSOR POLLICUS BREVIS
  2. MEDIAL BORDER:
    EXTENSOR POLLICUS LONGUS
50
Q

which flexor muscle is actually classified as being in the Posterior Compartment?

A

BRACHIORADIALIS
as its attachments come from posterior side

51
Q

blood supply to the arm comes from which artery

A

RIGHT SUBCLAVIAN

52
Q
  1. what make the Borders of the Cubital Fossa?
  2. what pass through the Cubital Fossa?
  3. which 3 superficial Veins can be found in the Cubital Fossa
  4. which Vein is used for Venepuncture?
A
    • EPICONDYLES
      - Lateral border of the PRONATOR TERES
      - Medial border of BRACHIORADIALIS
  2. RN BT BA MN
    - RADIAL NERVE
    - BICEPS BRACHI TENDON
    - BRACHIAL ARTERY
    - MEDIAN NERVE
  3. BASILIC VEIN
    MEDIAN CUBITAL VEIN
    CEPHALIC VEIN
  4. Venepuncture: Median Cubital Vein
53
Q

what is the angle between the Anatomical Axis and the Mechanical Axis

A

174 DEGREES

54
Q
  1. where do the Iliopsoas muscles attach?
  2. which muscles Prevent Pelvic Drop and the case of Trendelenburg Gait?
  3. where do these attach?
A
  1. to LESSER TROCHANTER of FEMUR
    (hip flexors)
  2. GLUTEUS MEDIUS and MINIMUS (abductors)
  3. attach to GREATER TROCHANTER
55
Q
  1. Internal Iliac gives rise to which Arteries
  2. External Iliac becomes which artery? gives rise to which branches?
  3. what supplies the Neck of the Femur?
  4. what supplies the Proximal Head of the Femur
  5. what supplies the Distal Head of the Femur?
  6. what is the main supply to the Head of the Femur?
  7. what is the pathway of the Femoral Artery?
A
  1. INTERNAL ILIAC -> SUPERIOR GLUTEAL & INFERIOR GLUTEAL arteries
  2. EXTERNAL ILIAC -> FEMORAL ARTERY
    -> PROFUNDA FEMORIS (DEEP ARTERY OF THE THIGH)
    -> MEDIAL & LATERAL CIRCUMFLEX
  3. Femur NECK : LATERAL CIRCUMFLEX
  4. PROIMAL HEAD: ARTERY OF THE LIGAMENT OF THE FEMUR (through Fovea)
  5. DISTAL HEAD: MEDIAL CIRCUMFLEX
  6. MAIN HEAD: LATERAL EPIPHYSEAL ARTERY
  7. FEMORAL ARTERY (through femoral triangle)
    through ADDUCTOR HIATUS (in ADDUCTOR MAGNUS)
    POSTERIOR to become POPLITEAL ARTERY
56
Q

what are the Boundaries of the Femoral Triangle?

A
  • superior: INGUINAL CANAL (inferior border)
  • lateral: SARTORIUS (medial border)
  • medial: ADDUCTOR LONGUS (lateral border)
57
Q

impact of increased Vitamin D on
Parathyroid Hormone?
1-alpha-(OH)ase?
25(OH)ase?

A

INCREASED VIT D:

PTH: DECREASES
1-alpha-(OH)ase: DECREASES
25(OH)ase: INCREASES

58
Q
  1. what is Rickets due to?
  2. What is Osteomalacia
  3. which Stains are used to show histology of Osteomalacia?
  4. where are Vitamin D Receptors expressed?
A
  • LOW VITAMIN D
  1. Rickets:
    - WIDENING OF GROWTH PLATE
    - DELAY OF GROWTH PLATE MINERALISATION
    - Hypertrophic chondrocytes don’t apoptose
    - chondrocyte columns are lost
  2. Osteomalacia:
    SOFTENING of bone due to defective mineralisation of newly formed bone in a mature skeleton
  3. TOLUIDINE BLUE, VON KOSSA
  4. VDR: SKELETAL MUSCLE CELLS
    (low vitamin D -> muscle weakness)
59
Q

which bone has Tubercles?

which bone has Trochanters?

which bone has a Tuberosity?

  • list them in order of size and force:
A

TUBERCLES : HUMERUS

TROCHANTERS: FEMUR

TUBEROSITY: TIBIA

order:
small - TUBERCLE
middle - TUBEROSITY
large - TROCHANTER

60
Q
  1. Arm Extensors attach to which Epicondyle?
  2. Arm Flexors attach to which Epicondyle?
A

ELFM

  1. EXTENSORS: LATERAL EPICONDYLE
  2. FLEXORS: MEDIAL EPICONDYLE
61
Q
  1. where is Type I Collagen found?
  2. where is Type II Collagen found?
  3. where is Type III Collagen found?
  4. where is Type VI Collagen found?
  5. where is Type IX Collagen found?
  6. where is Type X Collagen found?
A

Type 1: BONE, SKIN, TENDONS, LIGAMENTS

Type 2: CARTILAGE (chondrocytes)

Type 3: high abundance in HEALING LIGAMENTS & CARTILAGE.
found alongside type 1 in smaller amounts

Type 6: MUSCLE TISSUES

Type 9: high in ARTICULAR CARTILAGE.
found alongside type 1

Type 10: MARKER for NEW BONE FORMATION
(Hypertrophic Chondrocytes)

62
Q

Fibrocartilage is the strongest. what does it have a High Abundance of?

A

TYPE 1 COLLAGEN

63
Q
  1. Knee Joint consists of which Bones?
  2. which Articulations?
  3. what is the role of the Menisci?
  4. which Meniscus is more likely to be Injured and why?
  5. what are the Primary Stabilisers of the knee joint and what are the Secondary Stabilisers?
  6. which Ligaments are more likely to Injure?
  7. what is the Test for Cruciate Injury?
  8. which Collateral Ligament is Thicker and Stronger?
  9. why is one less likely to injure?
A
  1. FEMUR, PATELLA, TIBIA
    (not fibula)
  2. TIBIOFEMORAL, PATELLOFEMORAL
  3. MENISCI : INCREASE BONY CONTACT AREA up to 60%
    & shock absorption, Proprioception
  4. MEDIAL MENISCUS (C-shape) more INJURY RISK
    - LESS MOBILE as it is well anchored to the Tibia
  5. Primary Stabilisers: CRUCIATE & COLLATERAL LIGAMENTS (ACL,PCL, MCL, LCL)
    Secondary Stabilisers: MUSCLES of Thigh and Leg
  6. MORE INJURY: ACL & MCL
  7. LACHMANN TEST for ACL & PCL
    - MOVEMENT SHOULD NOT BE MORE THAN 5 MM
  8. MCL : THICKER, STRONGER
  9. LCL LESS LIKELY INJURY as it is LOOSE IN FLEXION
    MCL more likely injury as there is more force on the medial side
64
Q
  1. what is the Ankle Joint known as?
  2. why is Dorsiflexion more Stable than Plantarflexion?
  3. which Joint allows Inversion and Eversion?
  4. what angle of movement is permitted for Inversion?
  5. what angle of movement is permitted for Enversion?
  6. how are the Medial and Lateral Ligaments?
  7. which is more prone to Injury from Hyperinversion?
A
  1. TALOCRURAL JOINT - Synovial Hinge, Uniaxial
    (Tallus with Tibia and Fibula)
  2. DORSIFLEXION more STABLE as TALLUS WIDE ANTERIOR fills joint space restricts movement
  3. SUBTALAR JOINTS (talo-calcaneal and talo-calcaneao-navicular) for INVERSION & EVERSION
  4. INVERSION: 35 DEGREES
  5. EVERSION: 20 DEGREES
  6. ONE THICK MEDIAL LIGAMENT : DELTOID (more stable)
    NUMEROUS THIN LATERAL LIGAMENTS
  7. HYPERINVERSION INJURIES: LATERAL LIGAMENTS
65
Q
  1. where does the Fibularis Longus attach?
  2. where does the Fibularis Brevis attach?
  3. which leg muscles pass Behind the Medial Malleolus?
  4. which muscles form the Calcaneal / Achilles Tendon?
  5. are the Toe Flexors anterior or posterior?
A
  1. FIBUALRIS LONGUS -> 1ST METATARSAL (across foot)
  2. FIBULARIS BREVIS -> 5TH METATARSAL
  3. FLEXOR POLLICUS LONGUS & FLEXOR HALLICUS LONGUS (posterior, deep) PASS BEHIND MEDIAL MALLEOLUS to the toes
  4. ACHILLES: TRICEPS SURAE - GASTROCNEMEUS (2) and SOLEUS
  5. TOE FLEXORS : POSTERIOR DEEP
66
Q
  1. what Nerve supplies the Anterior Leg?
  2. what Nerve supplies the Lateral Leg?
  3. what Nerve supplies the Posterior Leg?
  4. what movements do each of these nerves supply?
A
  1. ANTERIOR: DEEP FIBULAR NERVE
  2. LATERAL: SUPERFICIAL FIBULAR NERVE
  3. POSTERIOR: TIBIAL NERVE
  4. Deep Fibial: DORSIFLEXION & INVERSION
    Superficial Fibial: EVERSION
    Tibial: PLANTARFLEXION
67
Q
  1. where does Musculocutaneous Nerve supply?
  2. where does the Radial Nerve supply?
  3. where does the Ulnar Nerve supply / which muscles?
  4. where does the Median Nerve supply / which muscles?
  5. which nerve is damaged if there is Weakness of Triceps Brachii?
  6. which nerve is damaged if you are unable to Flex 2nd and 3rd digits?
  7. which nerve is damaged if cannot extend thumb or fingers?
  8. which nerve is damaged if cannot adduct wrist?
  9. which nerve is damaged if cannot adduct/abduct fingers?
A
  1. MUSCULOCUTANEOUS : ANTERIOR ARM (upper)
  2. RADIAL: POSTERIOR ARM & FOREARM
  3. ULNAR: medial
    forearm: FLEXOR CARPI ULNARIS
    & MEDIAL HALF of FLEXOR DIGITORUM PROFUNDUS
    Hand: ALL INTRINSIC MUSCLES EXCEPT THENAR
  4. MEDIAN:
    ANTERIOR FOREARM all except f.c.ulnaris and medial half of f. digitorum profundus
    THENAR MUSCLES (THUMB)
  5. Triceps brachii: RADIAL NERVE
  6. 2nd 3rd Digits flexion: MEDIAN NERVE
  7. Extend thumb and fingers: RADIAL
  8. Adduct
68
Q
  1. where does Musculocutaneous Nerve supply?
  2. where does the Radial Nerve supply?
  3. where does the Ulnar Nerve supply / which muscles?
  4. where does the Median Nerve supply / which muscles?
  5. which nerve is damaged if there is Weakness of Triceps Brachii?
  6. which nerve is damaged if you are unable to Flex 2nd and 3rd digits?
  7. which nerve is damaged if cannot extend thumb or fingers?
  8. which nerve is damaged if cannot adduct wrist?
  9. which nerve is damaged if cannot adduct/abduct fingers?
A
  1. MUSCULOCUTANEOUS : ANTERIOR ARM (upper)
  2. RADIAL: POSTERIOR ARM & FOREARM
  3. ULNAR: medial
    forearm: FLEXOR CARPI ULNARIS
    & MEDIAL HALF of FLEXOR DIGITORUM PROFUNDUS
    Hand: ALL INTRINSIC MUSCLES EXCEPT THENAR
  4. MEDIAN:
    ANTERIOR FOREARM all except f.c.ulnaris and medial half of f. digitorum profundus
    THENAR MUSCLES (THUMB)
  5. Triceps brachii: RADIAL NERVE
  6. 2nd 3rd Digits flexion: MEDIAN NERVE
  7. Extend thumb and fingers: RADIAL
  8. Adduct Wrist: Ulna
  9. adduct/abduct fingers: Ulna
69
Q
  1. where is the Femoral Nerve motor? and where is it sensory?
  2. where is the Obturator Nerve Motor? and where is it sensory?
  3. where is the Sciatic Nerve Motor? and where is it Sensory?
  4. what is the Branch of the Femoral nerve in the leg?
  5. what are the Branches of the Sciatic Nerve in the leg?
A
  1. FEMORAL NERVE
    MOTOR: ANTERIOR THIGH (quadraceps and sartorius)

SENSORY: ANTERIOR THIGH, ANTEROMEDIAL to KNEE, MEDIAL LEG & MEDIAL FOOD

  1. OBTURATOR NERVE
    MOTOR: MEDIAL THIGH (adductors)

SENSORY: PROXIMAL MEDIAL THIGH

  1. SCIATIC NERVE
    MOTOR: POSTERIOR THIGH (hamstrings) ALL OF LEG & FOOT

SENSORY: LATERAL LEG & FOOT

  1. FEMORAL NERVE -> GREAT SAPHENOUS NERVE (SENSORY to MEDIAL LEG)
  2. SCIATIC NERVE
    -> COMMON PERONEAL / FIBULAR
    -> DEEP FIBULAR : ANTERIOR
    -> SUPERFICIAL FIBULAR: LATERAL

-> TIBIAL : POSTERIOR
-> SURAL

70
Q
  1. which cartilage type has a high cell density?
  2. in Tendons and Ligaments, which Collagen type increases after injury?
  3. Hyaline cartilage has lots of which collagen
  4. which Stain is used for Articular Cartilage?
  5. which stain allows you to see Osteoclasts?
A
  1. elastic cartilage
  2. TYPE 3
  3. TYPE 2
  4. ARTICULAR CARTILAGE: SAFFRANIN O & FAST GREEN
    (glycoproteins orange, type 1 coll green)
    with Haematoxylin counterstain (purple cells)
  5. OSTEOCLASTS: TRAP STAIN
71
Q

in Tinbergen’s 4 Questions what is
How?
Why?

Now?
History?

A

HOW: PROXIMATE
WHY: ULTIMATE

NOW: SYNCHRONIC
HISTORY: DIACHRONIC

72
Q

what is the recovery of Stored Elastic Energy in Tendons known as

A

BOUNCING GAIT
(SPRING-MASS)

73
Q

the Gait Cycle

  1. Stance Phase :
  2. Swing Phase:
  3. which stage is the 1st Double Contact?
  4. when is the Single Limb Stance?
  5. when is the 2nd Double Contact?
A
  1. STANCE PHASE
    - INITIAL CONTACT
    - LOADING RESPONSE
    - MID STANCE
    - TERMINAL STANCE
    - MID-SWING
  2. SWING PHASE:
    - INITIAL SWING
    - MIDSWING
    - TERMINAL SWING
  3. 1ST DOUBLE CONTACT: INITIAL CONTACT
  4. SINGLE LIMB STANCE:
    LOADING RESPONSE, MIDSTANCE, TERMINAL STANCE
  5. 2ND DOUBLE CONTACT:
    PRE-SWING

Musculoskeletal System (18 decks)

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