Week 1 Flashcards
1
Q
Posterior fixation to axial skeleton?
A
Muscles to vertebral collumn
2
Q
Anterior fixation to axial skeleton?
A
Sternoclavicular joint
3
Q
What is apposition? Reposition? Opposition of thumb?
A
Gripping between fingers and thumb
Release of this
Thumb meets 5th digit
4
Q
Where is clavicle found?
A
From manubrium to acromion
5
Q
Where does scapula overlap ribs?
A
Ribs 2-7
6
Q
What does acromion process articulate with?
A
Clavicle
7
Q
What does glenoid cavity articulate with?
A
Humerus
8
Q
Label this.
A
9
Q
Name the three bony landmarks of the scapula and where they are.
A
Supraspinous fossa: above spine anteriorly
infraspinous fossa: below spine anteriorly
Subscapular fossa: posterior
10
Q
Which muscles hold the scapula in place?
A
Trapezius
Levator scapulae
Rhomboid minor/major
Serratus anterior
Pectoralis minor
11
Q
What is protraction/retraction of scapula?
A
Protraction: pushing
Retraction = returning to normal
12
Q
What is lateral rotation/abduction of scapula?
A
Tilt glenoid cavity upwards aka putting hand in air
13
Q
What is medial rotation/adduction of scapula?
A
Bring arm back down
14
Q
What is elevation/depression of scapula?
A
Shrugging shoulders
15
Q
What is contained in the axilla?
A
Brachial plexus
Lymph nodes
Axillary vessels
16
Q
What is axilla apex?
A
Continuous with neck root, top of axilla pyramid
17
Q
What is floor of axilla?
A
Upward arching sheet of skin = where you put deodorant on
18
Q
What is anterior wall of axilla?
A
Pectoral muscles
19
Q
What is posterior wall of axilla?
A
Subscapularis
Teres major
Latissimus dorsi
20
Q
What is medial wall of axilla?
A
Chest wall and serratus anterior
21
Q
What is lateral wall of axilla?
A
Humerus
22
Q
Attachments of pectoralis major?
A
2 heads: medial clavicle and sternum, upper 6 costal cartilages, aponeurosis of external obliques
Humerus: crest of greater tubercle and lateral lip of intertubercle groove
23
Q
Actions of pectoralis major (both heads)?
A
Protracts and depresses scapula: pushes and goes down
Adducts and medial rotation of humerus
24
Q
Action of pectoralis major (clavicle head)?
A
Flexes humerus
25
Action of pectoralis major (sternocostal attachment)?
Extends humerus
26
Innervation of pectoralis major?
Medial and lateral pectoral nerves
27
Attachments of pectoralis minor? Where is it found?
3rd-5th ribs
Coracoid process of scapula
Deep to major, triangular muscle
28
Actions of pectoralis minor?
Depresses shoulder
Pulls scapula and shoulder forward
Raises ribs in inspiration when scapula is fixed
29
Innervation of pectoralis minor?
Medial pectoral nerve
30
What do dorsal roots contain?
Afferent/sensory fibres
31
What do ventral roots contain?
Efferent/motor fibres
32
What do dorsal and ventral roots form?
Trunks in spinal ganglion
33
What passes through the intervertebral foramen?
Spinal nerves
34
What are rami?
Mixture of afferent and efferent fibres
35
What do dorsal rami supply?
Deep muscles
Skin on dorsum
36
What do ventral rami supply?
Limbs
Lateral and ventral (belly) trunk skin
37
Which spinal nerve roots are in the brachial plexus? Minor contribution from...?
C5-T1
C4, T2
38
Which types of nerve supply do the brachial plexus nerves do and where? Exception?
Sensory, motor and sympathetic to pectoral girdle and upper limb
Except trapezius
39
What is the back up mechanism in the brachial plexus?
Each terminal nerve is made from more than one spinal nerve root so if a spinal nerve is injured, the area supplied will still function
40
What is the organisation of the brachial plexus with numbers?
5 roots
3 trunks
6 divisions
3 cords
Branches to supply tissues
41
Draw the brachial plexus
Read That Damn Cavader Book
42
What are the terminal nerves of the brachial plexus?
Musculocutaneous
Axillary
Median
Radial
Ulnar
43
Where do brachial plexus roots emerge from?
Between scalene anterior and scalene medius muscles
44
What are the roots of the brachial plexus?
5 ventral rami of spinal nerves
45
What are the three trunks of the brachial plexus and what nerves are they composed of? Where are they found?
Upper - C5+C6
Middle - C7
Lower - C8+T1
In neck before clavicle
46
What do anterior divisions of brachial plexus supply?
Flexor muscles
Skin on front of upper limb
47
What do posterior divisions of brachial plexus supply?
Extensor muscles
Skin on back of upper limb
48
Where are BP divisions found?
Deep to middle 1/3 clavicle
49
Where are BP cords found and what are they named according to?
Posterior to axillary artery
According to position to axillary artery
50
3 BP cords and what are they made up of?
Lateral cord: anterior divisions of superior and middle trunks
Medial cord: anterior division of inferior trunk
Posterior cord: uniting posterior divisions of all 3 trunks
51
What branches are formed from the lateral cord of the BP?
Musculocutaneous nerve
Lateral root of median nerve
Lateral cutaneous of forearm
52
What does the musculocutaneous nerve pierce and supply? Where does it come from?
Pierces coracobrachialis muscle
Supplies coracobrachialis, biceps brachii and brachialis
C5-C7
53
What does the lateral and medial root of the median nerve supply?
Forearm flexors
Thenar eminence (base of thumb)
54
What do the terminal branches of the medial cord supply?
Medial root of median nerve
Ulnar nerve
3 cutaneous nerves
55
What does the terminal branches of the posterior cord supply?
Radial nerve
Axillary nerve
56
3 types of supraclavicular branches of BP?
Dorsal scapular
Long thoracic
Suprascapular
57
Where is dorsal scapular nerve from and what does it supply?
C5 ramus
Rhomboids
58
Where is long thoracic nerve from and what does it supply?
C5-C7 ventral rami
Serratus anterior
59
Where is suprascapular nerve from and what does it supply?
Superior trunk
Supraspinatus and infraspinatus muscle
60
3 main infraclavicular bracnhes?
Medial and lateral pectoral
Upper and lower subscapular
Thoracodorsal
61
Where are upper and lower subscapular nerves from and their innervation?
Posterior cord
Subscapularis and teres major
62
Thoracodorsal nerve innervation?
Lattisimus dorsi
63
Crutch palsy cause and effect?
Prolonged use of crutches
Affects radial nerve = extensors affected
64
Radial nerve damage cause and effect?
Caused by intramuscular injections into deltoid
Drop wrist = cant extend hand (gay hand)
65
Carpal tunnel syndrome cause and effect, symptoms?
Caused by repetitive wrist flexion
Median nerve damage
Numbness, tingling and pain in palm and fingers
66
Where does axillary nerve arise from? Functions?
Posterior cord: C5-C6
Teres minor: laterally rotates arm
Deltoid: abducts arm
Sensory innervation to inferior lateral shoulder
67
Where does ulnar nerve arise from? Functions? Sensory innervation?
Medial cord, C8-T1
Flexes and adducts wrist
Flexes fingers
Adducts thumb
Controls hypothenar (palm muscles) muscles
Flexes metacarpophalangeal joints
Extends interpharangeal joints
Abducts and adducts fingers
Sensory innervation: medial third of hand, little finger, medial half of ring finger
68
Where does the median nerve arise from? Functions? Sensory innervation?
Medial and lateral cords, C5-T1
Pronates forearm and hand
Abducts wrist
Flexes fingers and wrist
Controls thumb and thenar muscles
Flexes metacarpophalangeal joints
Extends interphalangeal joints
Sensory innervation: lateral 2/3 palm, thumb, index finger, middle finger, lateral half ring finger, dorsal tips of these fingers
69
Radial nerve origin, functions, cutaneous supply?
Comes from posterior cord of BP, C5-T1
Flexes elbow
Abducts and adducts wrist
Supinates forearm and hand
Extends fingers, elbow, thumb and wrist
Abducts thumb
Sensory innervation: posterior surface of arm and forearm, lateral 2/3 of dorsum of hand
70
Where does musculocutaneous nerve come from, functions, cutaneous supply?
Lateral cord, C5-C7
Flexes shoulder, elbow
Supinates forearm and hand
Sensory supply to lateral surface of forearm
71
Where is sternoclavicular joint? Joint type?
Notch of manubrium and medial clavicle
Synovial joint
72
How is sternoclavicular capsule thickened?
Sternoclavicular ligaments
73
Where are interclavicular ligaemnts?
Medial ends of clavicle
74
Where is the costoclavicular ligament found?
First costal cartilage and clavicle
75
Which type of joint is the acromioclavicular joint?
Gliding synovial between clavicle and acromion
76
What are the three ligaments of the acromioclavicular joint? Which is strongest?
Coracoclavicular - strongest
Acromioclavicular
Coracoacromial
77
Which type of joint is the glenohumeral joint and what is it made from? How is it stabilised and why?
Synovial ball and socket
Head of humerus and glenoid cavity
Rotator cuff muscles - stabilise joint without limiting it
78
Which structure deepens the glenoid fossa? What is it?
Glenoidal labrum - fibrocartilage ring around glenoid cavity
79
Where does the humerus fracture?
Surgical neck
80
Where are the radius, capitulum, ulna and trochlea anatomically?
Radius and capitulum: Laterally
Ulna and trochlea: medially
81
Functions of medial and lateral epicondyles?
Sites of muscle attachment
82
Attachments of synovial capsule in glenoid fossa?
Proximal: scapula beyond supraglenoid tubercle, margin of labrum
Distally: anatomical neck of humerus
83
What is bursae and its function? Where is it found?
Fluid filled sac lined by synovial membrane
In major joints reduces friction where one structure frequently moves over another
Subacromial, subscapular, subdeltoid and subcoracoid burse
84
Which muscles allow flexion?
Pecotralis major (clavicular head)
Anterior deltoid fibres (assisted by biceps brachii short head and coracobrachialis)
85
Which muscles allow extension from anatomical position?
Posterior deltoid fibres
Latissimus dorsi (asissted by scapula elevation and levator scapulae)
86
Which muscles allow extension to return to anatomical position?
Latissimus dorsi, teres major, pectoralis major (sternal head)
Assisted by rhomboid major and pectoralis minor
87
Which muscles allow abducion?
First 15-30 degrees = supraspinatus
Deltoid to horizontal
Lateral rotation of scapula to allow arm over head = serratus anterior (lower fibres) and trapezius (upper fibres)
88
Which muscles allow adduction?
Latissimus dorsi
Pectoralis major sternocostal fibres
89
Which muscles allow medial rotation?
Pectoralis major
Latissimus dorsi
Subscapularis
Teres major
90
Which muscles allow lateral rotation?
Infraspinatus
Deltoid (posterior fibres)
Teres minor
91
Which muscles have mechanical effect on the shoulder?
Deltoid
Teres major
Short head biceps brachii
92
Which muscles stabilise the shoulder joint?
Long head biceps brachii
Triceps brachii
Rotator cuff
93
How do rotator cuff muscles work?
Contract together = stabilising force
Contract individually = movement
94
Four rotator cuff muscles?
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
95
Location, function and innervation of teres minor?
Posterior to greater tubercle of humerus
Lateral rotation and stabilisation
Axillary nerve (posterior cord)
96
Location, function and innervation of infraspinatus?
Posterior/superior to greatus tubercle of humerus, infraspinatus fossa of scapula
Lateral rotation and stabilisation
Suprascapular nerve (upper BP trunk)
97
Location, function and innervation of supraspinatus?
Superior to greater tubercle of humerus, supraspinatus fossa of scapula
Abduction and stabilisation
Suprascapular nerve (upper BP trunk)
98
Location, function and innervation of subscapularis?
Lesser tubercle of humerus and subscapular fossa of scapula
Medial rotation and stabilisation
Subscapular nerve (posterior BP cord)
99
Which muscles are attached to scapula aside from rotator cuff?
Levator scapulae
Rhomboid major and minor
Trapezius
Serratus anterior
100
What happens in shoulder dislocation?
Fall on outstretched hand whilst arm abducted
Humeral head pushes against capsule
Tears ligaments and articular capsules
101
What happens in rotator cuff injuries?
When you use limb above horiszontal e.g. throwing
Tear supraspinatus tendon
Frozen shoulder = irritation and inflammation of tendons, shoulder stiffness
102
When can the axillary nerve be injured? Outcome?
Dislocation of humeral head
Paralysis of deltoid and loss of sensation in small area of skin over deltoid
103
Name 3 chondroid tissues
Articular cartilage
IVDs
Meniscus
104
What genetic processes happen with ageing?
Decreased tissue
Reduced synthetic capc=acity of differentiated cells
Altered levels of growth factors/cytokines
Reduced efficiency of functional tissue elements
105
Which syndrome in ageing is to do with:
Joints
Bone
Muscle
Osteoarthrtitis
Osteoperosis
Sarcopenia
106
Articular cartilage composition? Why is it slow to replicate?
Chondrocytes
No innervation/vascularisation or macrophages
107
Function of hydrophilic proteoglycans in ECM?
Maintain internal swelling pressure
108
What happens in articular cartilage with age?
Reduced water content
Fragmentation of protein components and collagen
Reduced tensile strength
109
What is osteoarthritis? Where is it common?
Disorder of synovial joints when damage, structural damage of joint occurs
Knee, hip, hand and wrist
Women
110
Pathogenesis of osteoarthritis?
Joint damage occurs e.g. injury/stress
Alter joint structure (cartilage loss, remodelling of bone, osteophytes, synovitis)
Repair process structurally alters joint
When repair processes can't compensate joint damage OA occurs
111
Osteoarthritis diagnosis?
45 and over
Activity related joint pain
No morning joint stiffness
112
Osteoarthritis management?
Individual management plans e.g. weight loss/exercise/footwear
Medication
Joint surgery
113
What happens on a cellular level in bone ageing?
Reduced numbers of osteoblasts
Less ability of osteoblasts to respond to mechanical forces
Increased osteoclasts relatively
Increased bone turnover
Decrease in growth hormone secretion
IGF-1 levels fall
114
What hormonal changes happen in bone ageing?
Decreased growth hormone secretion
Fall in IGF-1 level
Oestrogen inhibits osteoclast activity
Increased inflammatory cytokines (lifetime exposure to antigens)
115
What is osteoporosis?
Syndrome associated with low bone mass and deterioration of bone tissue = increased risks of fractures
116
Osteoblast function?
Synthesise bone matrix
Mineralisation
117
What is osteoid?
Non mineral matrix of collagen and non collagenous proteins
118
What happens in bone remodelling?
Activation: preosteoclasts stimulated + differentiate under influence of cytokines and growth factors into mature osteoclasts
Resorption: osteoclasts digest mineral matrix (old bone)
Reversal: resorption ends
Formation: osteoblasts synthesise new bone matrix
Queiescence: osteoblasts become resting bone lining cells on new bone surface
119
How often is bone replaced and when do bones weaken?
skeleton replaced every 10 years
bones weaken when excessive resorption happens
120
Risk factors for osteoporosis?
Age, female, genetics, fractures, ethnicity, rheumatoid arthritis, hypergonadism
Alcohol, smoking, low BMI, poor nutrition, vit d deficiency, Eds, low exercise, low calcium intake
121
How is bone mineral density calculated?
DEXA scan at hip and spine
122
What is normal T score, osteopenia and score for osteoporosis?
T = 0 is normal
T = -1 and =2.5 is low bone mass aka osteopenia
T = -2.5 is osteoporosis
123
What are fragility fractures? Common where?
Fractures from mechanical forces that usually wouldn't happen
Fall from standing height or less
Spine, hip, wrist
124
How to prevent osteoporosis?
Regular weight exercise
Healthy diet
Sufficent vitamin D
Avoid smoking/alcohol
125
Name the antiresorpitive osteoporosis treatments?
Bisphosphonates - oral and IV
Densosumab - Subcutaneous rank ligand inhibitor
Raloxifene
126
Name anabolic osteoporosis treatment?
Teriparitide - stimulates bone formation
Subcutaneous injection
Specific criteria
127
What is muscle ageing?
Progressive loss of skeletal muscle mass/function
128
Sarcopenia definition?
Progressive skeletal muscle disorder associated with increased likelihood of falls, fractures, disability and mortality
Low muscle strength due to decline in skeletal mass
129
What 3 things are used to categorise sarcopenia?
low muscle strength
low muscle quantity/quality
low physical performance
130
What is used to categorise severity of sarcopenia? What is primary sarcopenia?
Physical performance
Ageing
131
What is secondary sarcopenia caused by?
Activity: bed rest, sentry lifestyle, zero gravty
Disease: organ failure, malignancy, inflammatory/endocrine disease
Nutrition: inadequate energy or protein intake
132
What is SARC-F screening tool?
Strength: difficulty lifting and carrying 10 pounds
Assistance: difficulty walking across a room
Rise: difficulty transferring from chair to bed
Climb: difficulty climbing 10 stairs
Falls: how many falls in past year
133
Diagnosis of sarcopenia?
Handgrip strength
Chair stand strength
Gait speed
CT/MRI
DEXA SCAN
Bioimpendance analysis
134
Diagnosing sarcopenia?
SARC-F or clinical suspicion
Measure grip strenfth
Measure physical performance
135
Cons of sarcopenia?
Higher mortality
Hospitalisation
Frailty sydrome
136
Sarcopenia treatment?
Resistance/aerobic exercise
Increased protein intake
Vit D supplements if deficient
137
Consequences of msk ageing?
Altered gait/balace = falls
Increased injury
Chronic pain
Social isolation
Loss of independence = care home
138
Which type of bone is more susceptible to osteoperosis and why?
Trabecular: has greater surface area and is remodelled more rapidly than cortical bone
139
Where is cortical bone found?
Compact: diaphyses of long bones
140
Where is trabecular bone found?
Spongy: vertebral bodies and ends of long bones
141
Bone composition?
70% inorganic hydroxyapatite mineral calcium
22% organic collagen type I
8% water
142
Which noncollagenous protein is specific to bone?
Osteocalcin
143
Functions of noncollagenous proteins?
Attchment of bone cells to bone matrix
Regulating bone cell activity
144
Osteocyte functions?
Embedded in bone matrix
Have lancuna
Sense mechanical strain
Release signalling molecules e.g. prostaglandins, nitric oxide
145
What happens to osteoblasts after mineralising osteoid?
Become osteocyte
Apoptosis
146
Where are osteoblasts, osteocytes and osteoclasts derived from?
OB, OCy: mesenchymal stem cell
OC: haemopoeitic mononuclear cells
147
4 stages of bone remodelling? What happens and why?
Resorption: osteoclast recruitment, differentiation, activation
Reversal: osteoclast removal/apoptosis, osteoblast recruitment, differentiation, activation
Formation: matrix synthesis
Queiescence: mineralisation
Due to bone damage
148
How long does remodelling take?
6 months
149
Which enzyme are osteoclasts rich in?
tartar resistant acid phosphatase TRAP
150
Which molecule interaction stimulates resorption?
RANK-RANKL
151
How does osteoprotegerin inhibit resorption?
Expressed by osteoblasts/bone marrow cells
Binds to RANKL, acts as decoy
Prevents RANK activation
152
How do osteoclasts resorb bone?
Form tight seal over bone surface
Secrete hydrochloric acid and proteolytic enzymes
Acid dissolves hydroxyapatite, giving access to enzymes to dissolve colllagen/bone matrix proteins
153
Cathespin K function?
Proteolytic enzyme degrading matrix
154
Carbonic anhydrase function?
Acid generation
155
CBFA1 function?
Converts mesenchymal stemcell/pre-osteoblast to osteoblast
156
Osteoblast shape?
Cuboidal cells
157
Which 2 molecules determine whether an osteoclast will mature?
OPG = negative feedback
RANKL = positive feedback
158
Which molecules stimulate RANKL?
Parathyroid hormone
TNF
IL-1
159
Where are most receptors for hormones/growth factors/cytokines in bone?
Osteoblasts
160
What hormone regulates expression of RANKL pre-menopause?
Estrogen
161
Which cells express RANKL?
Osteoblast lineage cells and many others e.g. lymphoid cells
162
What causes maturation of osteoclasts?
RANK binding to RANKL on osteoclasts
163
What happens when RANKL is bound to opg? What is OPG?
Osteoclasts cannot form, function or survive
a Protein
164
What do osteocytes secrete to prevent wnt signalling and therefore resorption?
Sclerostin
165
Describe what happens when a crack appears in bone.
Osteocytes near crack undergo apoptosis
They detect strain and secrete GH, PGs, Nitric oxide
Lining pulls away from bone matrix
Stromal cells released due to sclerostin inhibiton
They generate pre-osteoblasts and secrete macrophage colony stimulating factor - helps generate pre-osteoclasts
Pre-osteoblasts express RANK-L, pre-osteoclasts have RANK receptors
Mature osteoclasts form and resorb bone, then apoptose
Mature osteoblasts form and secerete OPG
Osteoblasts secrete osteoid and mineralise it
Matrix accumulates mineral
166
How long is primary and secondary mineralisation?
Primary = <100 days, 5 days after osteoid synthesis
Secondary = slower and increases number and size of hydroxapatite crystals
167
What is degree of bone mineralisation dependent on?
Amount of solid protein present
Enamel has most mineralisation
168
Stimulators vs inhibitors of bone remodelling?
Stimulants: parathyroid hormone, growth hormone, IL-1, TNF, IL-6, prostaglandins
Inhibitors: estrogen, androgen, calcitonin, OPG, interferon gamma, progesterone
169
Why do boys hit puberty later than girls?
Girls reach peak BMD before boys
170
What happebs to bones during puberty?
Increased suze if vertebrae
Increased thickness of trabeculae
Increased bone length and diameter
171
When do men and women hit peak bone mass? Why do womens bones decrease in mass faster?
30-40
Menopause due to estrogen deficiency
172
4 determinants of peak bone mass?
Genetics
Lifestyle
Hormones
Nutrition
173
How does estrogen affect bones?
- Allows normal bone maturation and mineral acquisition
- Can affect ECM through chondrocytes
174
Androgen role in bones?
Mineral accrural
175
How can estrogen deficiency cause bone loss?
E restrains bone turnover
E maintains calcium fluxes in intestine and kidneys
Can induce osteoclast apoptosis
Can lead to excess RANKL which increases bone resorption
176
3 main points of osteoperosis?
Decreased bone mass leading to increased chance of fracture, with decreased bone strength
177
What is a Colle's fracture? Feature?
Fracture caused by falling onto outstretched hand
Dinner fork - wrist is bent back
178
How can patients lose height?
Collapsed vertebrae from compression fractures
179
Risk factors for osteoperotic fractures?
Age >65
Vertebral compression fracture
Fragility fracture >40
Hyperparathyroidism
Osteopenia
Hypergonadism
Early menopause
180
Complications of osteoporitic fractures?
Permanent disability
Loss of independance
Many die 1 year after fracture
Kyphosis
Loss of height
Back pain
Deformity
181
2 determinnts of fracture risk?
Bone strength
Propensity to fall
182
What is T score?
Number of standard deviations above or below the mean for a healthy adult population of same sex and ethnicity
183
Normal, osteopenia and osteoperosis t score? What is established osteoporosis?
Normal = 0, -1
Osteopenia = -1 to -2.5
Osteoporisis = less then -2.5 or equal
Established is osteoporosis with a fracture
184
How is bone density measured?
Dual energy x ray absorpitometry
185
How to calcualte absolute fracture risk?
Age
Past fracture history
BMD
186
Lifestyle changes for postmenopausal patients?
Dietry calcium
Weight bearing and muscle strengthening exercise
Stop smoking
Drink less
187
How to minimise fall risk?
Avoid sedative drugs
Treat neurological conditions
Balance training
Occupational therapy = home mods
Hip protectors
188
Effect of estrogen HRT on BMD?
Slows decline of BMD
189
Consequences of HRT?
Increased risk of disease e.g. heart attack, stroke, DVT
Not recommended for woman
190
What is estradiol?
Estrogenic hormone treating menopause symptoms
Prevents osteoperosis
191
What is raloxifene?
Selective estrogen receptor modulator SERM
Manages postmenopausal osteoporosis
192
How do SERMs work?
Bind to estrogen recptor, it undergoes conformational change
193
How do bisphosphonates work?
Decrease bone remodelling by binding to surface of bone
Increased bone mineral density, increased bone strength
Either by increasing osteoclast death or inhibiting osteoclast activity
194
Name 2 bisphosphonates
Alendronate
Zolendonic acid
195
Funcion of parathyroid hormone receptor? Type of receptor?
Controls level of calcium in blood
Bone formation role
GPCR
Decreases fractures
196
Strontium ranelate function?
Increases pre-osteoblast replication into osteoblasts = increased bone matrix synthesis
Reduces pre-osteoclast differentiation into osteoclasts
Increases BMD, decreases fracture risk
197
Denosumab function?
Binds RANKL to inhibit osteoclast formation/function/survival
Reduces fractures
198
Romosozumab function? Type of drug? What is it?
Inhibits sclerostin
Sclerostin usually inhibits bone formation
Subcutanous injection
Monoclonal antibody
Decreases bone resorption, increase bone formation
199
How does treatment affect fracture risk?
Decreases it by half
200
How to know if osteoporosis treatment is working?
Fewer fractures
DXA measurement
201
How is ca distributed in the body?
99 percent mineral in bone
1.2mmol/l extracellular ionised
less intracellular cystolic
202
Calcium functions?
Muscle contraction
intracellular messenger
nerve excitability
blood coagulation
203
Distribution of serum calcium?
47 percent free aka unbound / ionised
47 percent bound to albumin
6 percent complexdd
204
Why is free calcium important?
feedback mechanisms regulated by free calcium
205
what is total calcium?
bound and free
206
What happens when patient has low albumin?
total calcium low but free calcium normal
207
how to calculate adjusted calcium?
total calcium + 0.02(45-alb)
208
normal range of serum calcium?
2.2 - 2.6 mmol/L
above is hypercalcaemia
below is hypocalcaemia
209
organs involved in calcium homeostasis?
kidney
gut
bone
parathyroid glands
210
parathyroid gland function?
senses calcium
211
hormones involved in calcium homeostasis?
parathyroid hormone
1,25 dihydroxyvitamin d
212
what is calcitriol?
active form of vitamin d
213
how much calcijm do we get in our diet per day?
25mmol
214
how is calcium absorbed?
1.25 dhcc
duodenum and jejenum
active transport pathway controlled by 1.25 dhcc
passive diffusion depending on luminal ca conc
215
how much calcium is absorbed daily?
20-60 percent
changes when dietry intake falls or during growth, pregnancy, lactation
216
how much calcium is reabsorbed in kidney and where? coupled with?
65 percent
proximal tubule
bulk transport of solutes e.g. na and water
217
what allows ca reabsorption from kidney?
parathyroid hormone
218
what allows ca resorption from bone?
parathyroid hormone
1.25 dhcc
219
what is parathyroid hormone secretion regulated by? what is it?
free calcium - calcium sensing receptors
amino acid polypeptide produced by parathyroid gland
220
what type of receptor is calcium sensing receptor? where are they?
GPCR
parathyroid cells
remal tubule
221
cinacalet function?
reduced pth secretion in patients with primary hyperparathyroidism and parathyroid cancer
222
parathyroid hormone actions?
stimulates renal tubular calcium reabsorption
-promotes bone resorption
stimulates formation of 1.25 dhcc in kidney = enhance ca absorptiom from gut
allows rise in ionised ca to normal
223
Where is vitamin D obtained from? Where is it converted to active forms?
Sunlight and diet
Cholecalciferol is converted to 25OH cholecalciferol in the liver
25OH cholecalciferol is converted to 1,25(OH)2 cholecalciferol in kidney
224
Which 3 things can activate vitamin D in kidney from 25OH cholecalciferol?
Parathyroid hormone
Hypocalcaemia
Hypophosphataemia
225
What happenns when ionised calcium levels fall?
parathyroid hormone increases
1,25 dihydroxycholecalciferol increases in kidney to enhance sodium absorption from gut
renal tublar calcium reabsorption
bone resorption
226
Causes of hypocalcaemia?
Hypoparathyroidism
Vitamin D deficiency/renal disease
227
Causes of hypoparathyroidism? (not enough PTH)
Neck surgery - may affect thyroid
Idiopathic (random)
Magnesium deficiency - required to absorb calcium
228
Causes of vitamin D deficiency?
Malabsorption
Little exposure to sunlight
229
How can vitamin D problems be caused by renal disease?
Kidneys fail to make active form DHCC
230
Hypercalcaemia causes?
Hyperparathyroidism
Vitamin D overconsumption/overdose
231
Hyperparathyroidism cause?
Adenoma of parathyroid gland
232
Difference between hypercalcaemia caused by hyperparathyroidism and malignancy?
Hyper - increased calcium and increased PTH
Malignancy - increased calcium and suppressed PTH
233
Which peptide causes hypercalcaemia and where is malignancy observed?
PTH related peptide
Lung/breast/multiple myeloma
234
Functions of phosphate?
Skeletal development
Bone mineralisation
Composition of cell membranes, nucleotide structure, cell signalling
235
Distribution of phosphate in body?
85% mineralised in bone
Predominantly intracellular bound to lipids and proteins
1% in EC fluids
236
What is phosphate bound to?
Cell membranes, nucleic acids, glycolytic intermediates, ATP
237
What does phosphate shift between?
Organic phosphate pool and inorganic pool
In and out of cells
238
Example of phosphate moving into cells?
Insulin mediated entry of glucose into cells after meals results in phosphate moving into cells
239
What is the true number of phosphate stores?
Serum phosphate numbr
240
Organs and hormones involved in phosphate homeostasis?
Kidney, gut, bone
Paeathyroid hormone, fibroblast growth factor 23, 1,25 DHCC
241
Where is phosphate absorbed? Where does it come from?
Small intestine
Plentiful in diet
242
Which phosphate condition causes activaton of vitamin D?
Hypophosphateaemia
243
How much phophate is protein bound? How much is filtered in kidney and wher?
15-20% protein bound
80% left
75% proximal tubule reabsorption
20% in distal tube
244
What inhibits reabsorption of phosphate by renal tubule?
PTH
FGF23
245
What happens when serum phosphate levels increase?
Decreased ionised calcium
Increased PTH
Increased urine phosphate excretion
Increased FGF23
246
What influences serum phosphate values?
Diurnal variation rhythm: nadir before noon, peak after noon
Dietary effects: rise after meals then falls due to insulin
High in infancy when growing
247
Where is calcium mainly reabsorbed?
Duodenum and jejenum
248
How can phosphate absorption be increased?
1.25 DHCC
In entire small intestine
249
What is the population growth rate?
Rate at which number of individuals in a population increases in a given time period
Expressed as fraction of initial population
250
What is the rule of 70?
Divide number 70 by expected rate of growth (%)
Estimate in years produced e.g. 70/1.09 = 64 years
Doubling time
251
2 things world population growth is determined by?
Births and deaths and migration
252
What is the crude birth rate?
number of live births/1000 persons/year
253
What is the crude death rate?
number of deaths/1000 persons/year
254
What is replacement level fertility? High vs low income countries?
Number of children a couple must bear to replace themselves
Higher than 2
2.1 for high income country, 2.5 for low income because some female children die before reaching reproductive years
255
What is the total fertility rate?
Average number of children that would be born to a woman during her lifetime if she passed through all her reproductive years from 15-44
Aka average number of children a woman will bear
256
Factors affecting birth rates?
Education/affluence levels
Importance of children in family labour force
Urbanisation
Cost of raising chldren
Education/employment for women
Marriage age on average
Infant mortality rate
Birth control availability
Religion/culture
257
Factors affceting death rates?
Sanitation/safe drinking water
Nutrition
Income level
Infectious diseases/vaccination
Urbanisation
Education
Health care access
258
What are demographics?
Scientific study of human populations especially with reference to their size, structure and distribution
259
What does demographic transition mean?
Transition from high birth and death rates to low birth and death rates as a country develops from a pre industrial to industrialised econmic system
260
What is an age pyramid?
Illustration of distribution of various age groups in a population
Forms pyramid when population is growing aka low income country
261
Before vs after demographic transition?
Before: high birth/death rates, low life expectancy, smaller population, population growth low
After: birth/death rates low, high life expectancy, large population, low population growth
262
What is epidemiology?
Science and practice which describes and explains disease patterns in populations
263
What is epidemiological transition?
Long term shift in pattern of disease in a country away from infectious disease to degenerative disease
264
Where is population ageing fastest? Scotland?
Fastest in low and middle income countries e.g. cuba, mongolia
Scotland has increasing proportion of older people in population
265
Life expectancy scotland men vs women?
Men - 77
Women - 81
266
What is compression of mrotality?
A greater proportion of deaths occur during a narrow time period at upper limit of human life span
267
What is compression of morbidity?
Scenario where increasing proportion of population will live long, health life in which death will be preceded by a very short period of ill health
268
Leading contributor to disablity? Effect?
Lower back pain
Signidicantly limit mobility and dexterity, leading to early retirement, lower levels of wellbeing, reduced ability to participate in society
269
Why are number of people with MSK conditions rapidly increasing?
Population increases and ageing
270
Examples of MSK conditions?
Fractures/sprains/strains
Low back pain, osteoarthritis
271
Main reasons for premature exit from workforce?
Low back pain
272
How many adults over 65 have long term condition of MSK system?
1 in 3
273
What are years lost to a disability?
Number of years with a lower quality of life due to a disease
274
What are DALYs?
Disability adjusted life year
Loss of equivalent of one year of health
275
What are incidence rates?
Number of new events (disease etc.) occuring in a specified time period in defined population excluding prevalnt cases
276
What is prevalence?
Number of cases of disease or other health outcome present in specific time period in defined population
277
Health definition?
State of complete physical mental and social well being and not merely the absence of disease or infirmity
Chronic illness = ill
278
What is wellbeing?
Integrates mental health and physical health resulting in more holistic approaches to disease prevention and health promotion
279
What is ageing associated with?
Progressive and generalised impairment of functioning resulting in a loss of adaptive response: lung function, circulation, muscles, nerves, immune system
280
What can stepwise deterioration in physiological function be caused by? Name of this model?
Bereavement
Falls
UTIs
Extension of morbidity model
281
How to measure health?
Functional status
Activites of daily life
Wellbeing
282
WHO 6 domains of quality of life?
Physical
Environment
Social relationships
Psychological
Level of dependence
Spiritual
283
Impacts of chronic musculoskeletal disorders on quality of life?
Chronic disease morbidity
Long term pain
Sleep disturbance
Exacerbate symptoms of anxiety and depression
Accessibility problems
Social intercations
Drug side effects
284
What does care seeking behaviour due to musculoskeletal disorders seem to depend on?
Factors associated with symptoms severity and persistence
Mental distress and depression
285
What are QALY?
A full year of life quality
Years of healthy life lived
(DALYs are years of healthy life lost)
286
How to add more QALYs to people?
Early interventions
Olfer people at heart of community
Plan for needs of older people
Value their contribution to society
Provide affordable health care
