week 1: musculoskeletal system Flashcards

1
Q

what are the characteristics of bones in patients with osteomalacia & rickets?

A

soft, very flexible & easily deformed

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2
Q

what type of bone are the vertebra & hip bones?

A

irregular bones

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3
Q

fill in the blank:

insertion = the ___ point of muscle attachment

A

the moveable point of muscle attachment

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4
Q

what is a foramen?

A

a round or oval opening

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5
Q

label the surface feature of the tibia

A
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6
Q

what type of cartilage is the menisci?

A

fibrocartilage

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7
Q

label the joint (articular) surfaces on the femur

A
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8
Q

what do a joint cavity in a synovial joint do?

A

separates articulating bones & contains synovial fluid

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9
Q

bones are organs (tue/flase)

A

true

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10
Q

label the surface feature of the humerus

A
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11
Q

what are rotational movements?

A

turn a bone around its own longitudinal axis

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12
Q

what causes osteoporosis?

A

bone resorption outpaces bone deposition - reduction in bone mass compromises normal bone function

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13
Q

bones display surface features otherwise known as?

A

landmarks

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14
Q

what is a crest?

A

a prominent bony ridge

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15
Q

what is a depressed fracture?

A

broken bone is pressed inwards

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16
Q

where does interstitial bone growth occur?

A

at the epiphyseal plates of long bones

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17
Q

do synovial joints have a joint cavity?

A

yes

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18
Q

what 2 movements does a hinge joint allow?

A

flexion & extension

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19
Q

what type of bone is the patella?

A

short bone - sesamoid bone

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20
Q

bones widen by interstitial growth (true/false)

A

false - appositional growth

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21
Q

what is cartilage composed of?

A

chondrocytes & an extracellular matrix (ground substance, collagen & elastin fibres)

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22
Q

costal cartilage is what type of cartilage?

A

hyaline

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23
Q

what 2 layers/membranes make up the articular capsule

A

outer fibrous layer

inner synovial membrane

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24
Q

what is a spiral fracture?

A

ragged break that occurs when excessive twisting forces are applied to a bone

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25
Q

bone remodelling occurs throughout life (true/false)

A

true

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26
Q

what are 2 examples of a pivot joint?

A

proximal radioulnar

atlas-axis joints

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27
Q

spongy bone is heavier than compact bone (true/false)

A

false - reduces the weight of the skeleton

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28
Q

what do plane joints allow?

A

gliding movements

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29
Q

in muscle relaxation what happens after Ca+ ions are actively pumped back into the SR?

A

troponin returns to its original shape

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30
Q

the skull includes:

A

cranial & facial bones

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31
Q

what is bone deposition?

A

osteoblasts produce “new” matrix

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32
Q

during muscle contraction what happens after voltage-gated Ca2+ channels open & Ca2+ enters the axon terminal

A

synaptic vesicles release ACh into the synaptic cleft

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33
Q

how does weight-bearing exercise affect bone growth & remodelling?

A

mechanical forces stimulate osteoblasts to produce new matrix - bones become thicker, stronger & more resistant to fractures

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34
Q

what does each osteon act as and what forces do they resist?

A

act as a tiny weight-bearing pillar

resist forces applied to the ends of a bone

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35
Q

what are muscle fibres?

A

large multi-nucleated cells

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36
Q

what are thin myofilaments composed of?

A

actin

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37
Q

what specialised bone cell is this?

A

osteocyte

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38
Q

fill in the blank:

yellow bone marrow consists of ___ cells

a potential ___ source

A

yellow bone marrow consists of adipose cells

a potential energy source

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39
Q

what 3 things are involved in fracture treatment?

A
  1. reduction
  2. immobilisation
  3. rehabilitation
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40
Q

what does the articular capsule do?

A

surrounds entire joint & encloses joint cavity

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41
Q

in muscle relaxation what happens when the sarcolemma returns to its resting state (RMP)?

A

Ca+ release channels in the SR close

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42
Q

what are the 2 possible functional classifications of fibrous joints?

A

synarthrosis or amphiarthrosis

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43
Q

in healthy young adults the rate of bone deposition is not equal to the rate of resorption (true/false)

A

false

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44
Q

with age, a decline in what results in a loss of bone mass?

A

sex hormones

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45
Q

list 2 passageways for blood vessels, nerves & sound

A

foramen

canal/meatus

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46
Q

what does the central canal of an osteon contain?

A

blood vessels & nerves

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47
Q

what 2 layers & 2 tissue membranes does every bone have?

A

outer layer of compact bone
internal layer of spongy bone
outer connective tissue membrane (periosteum)
internal connective tissue membrane (endosteum)

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48
Q

the rib cage includes:

A

the sternum & ribs

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49
Q

what is the condyle of a joint surface?

A

a smooth rounded surface at the end of a bone

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50
Q

during muscle contraction what happens after synaptic vesicles release ACh into the synaptic cleft?

A

ACh diffuses across the synaptic cleft & binds to chemically-gated ion channels (nicotinic receptors) on the sarcolemma

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51
Q

describe the cartilage in cartilaginous joints

A

hyaline or fibrocartilage unites articulating bones

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52
Q

label the osteon

A
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53
Q

what is a canal or meatus?

A

passageway through bone

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54
Q

what 2 things do growth hormone (GH), thyroid hormone (TH), testosterone (males) & oestrogen (females) do during adolescence?

A
  1. promote the adolescent growth spurt

2. end growth - induce epiphyseal plate closure

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55
Q

what is the function of the bones of the pelvic girdle?

A

attach the lower limbs to the axial skeleton

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56
Q

what is a trochanter?

A

a large, irregular shaped projection

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57
Q

what is a transverse fracture?

A

bone completely breaks across the diaphysis

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58
Q

list 2 examples of a ball & socket joint

A

shoulder

hip joints

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59
Q

what does this diagram display?

A

interstitial growth

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60
Q

in long bones, spongy bone is mainly found in the proximal & distal epiphysis (true/false)

A

true

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61
Q

what are short bones?

A

small cube shaped bones

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62
Q

what do sensory neurons & blood vessels do in synovial joints?

A

sensory neurons detect pain & monitor proprioception

blood vessels mainly supply synovial membrane

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63
Q

the appendicular skeleton includes the bones of the: (4)

A

upper limbs, lower limbs, shoulder (pectoral) girdles & pelvic girdle

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64
Q

label the spongy bone

A
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65
Q

what 5 movements do condylar joints allow?

A

flexion, extension, adduction, abduction & circumduction

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66
Q

in muscle contraction what happens after myosin heads bind to actin active sites on the thin myofilaments?

A

myosin heads pull the thin myofilament towards the center of the sarcomere (M-line) & then detach

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67
Q

in the role of movement, what do bones act as to move body parts?

A

levers

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68
Q

the auricle has what type of cartilage?

A

elastic

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69
Q

what characteristics do calcium phosphate crystals give bone?

A

make our bones hard & provide compressive strength

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70
Q

in muscle contraction what happens after troponin pulls tropomyosin away from the actin active sites?

A

myosin heads bind to the active sites, forming cross bridges & contraction begins

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71
Q

what do you call a fracture where the bone is crushed?

A

compression fracture

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72
Q

what are the 3 steps of interstitial growth in long bones?

A
  1. new cartilage forms at the top of the epiphyseal plate
  2. bone replaces old cartilage at the bottom of the plate
  3. diaphysis lengthens
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73
Q

what are thick myofilaments composed of

A

myosin

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74
Q

what 3 things make up connective tissues in bones?

A

osseous tissue
adipose tissue
hyaline cartilage (growth plates)

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75
Q

how many bones make up the human skeleton?

A

206

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76
Q

what are the 5 functions of bones?

A
support
protection
storage of minerals & triglycerides
blood cell production
movement
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77
Q

how do you describe synovial joints functionally?

A

diarthrosis

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78
Q

how is osseous tissue arranged in spongy bone?

A

into an irregular lattice of thin needle-like structures called trabeculae

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79
Q

what is a scaphoid fracture?

A

common carpal bone fracture

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80
Q

during muscle contraction what happens after the sarcolemma depolarises and a GP is produced?

A

GP opens voltage-gate Na+ channels in the sarcolemma

AP produced

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81
Q

what do you call a fracture where a tendon or ligament pulls off a fragment of bone?

A

avulsion fracture

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82
Q

what are bones/do bones lack in patients with osteomalacia & rickets?

A

poorly mineralised

lack calcium phosphate crystals

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83
Q

what is involved in ‘reduction’ during fracture treatment?

A

the realignment of bone ends

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84
Q

what are flat bones?

A

thin, flat & often curved bones

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85
Q

what are the 4 tissues that make up bones?

A

connective
nervous
muscle
epithelial

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86
Q

what are the 3 types of cartilage?

A

hyaline
fibrocartilage
elastic

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87
Q

what are the 6 types of synovial joints?

A
pivot
plane
condylar
saddle
hinge
ball & socket
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88
Q

bones are classified into 4 groups according to what?

A

shape

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89
Q

do fibrous joints have a joint cavity?

A

no

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90
Q

label the synovial joint

A
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91
Q

bone lengthens by appositional growth (true/false)

A

false - interstitial growth

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92
Q

what are myofibrils composed of?

A

contractile units called sarcomeres

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93
Q

what is an open (compound) fracture?

A

broken bone protrudes through the skin

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94
Q

what is a menisci & what are it’s 3 functions?

A

discs of fibrocartilage
stabilise joint
reduce friction
shock absorption

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95
Q

what does the axial skeleton include?

A

bones of the skull, vertebral column & rib cage

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96
Q

what type of bones are the tarsals, carpals & patella?

A

short bones

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97
Q

what are the 4 bone shapes

A

long
short
flat
irregular

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98
Q

what are the 4 functions of synovial fluid?

A

shock absorption
reduces friction
supplies oxygen & nutrients to chondrocytes
removes wastes

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99
Q

what is the head of a joint surface?

A

a rounded expansion at the end of a bone

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100
Q

label the thick myofilament

A
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101
Q

label the surface features of the ulna & radius

A
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102
Q

what 5 vitamins & 2 elements affect bone growth & remodelling?

A

vitamins C, A, D, K & B12

calcium & phosphate

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103
Q

in muscle contraction what happens after the AP stimulates sarcoplasmic reticulum Ca2+ release channels to open?

A

Ca2+ flows into the cytoplasm of the muscle fibre

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104
Q

what does articular cartilage do?

A

covers the ends of each articulating bone
shock absorption
reduces friction

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105
Q

what 3 things do osteons consist of?

A

a central canal
concentric circles of matrix
osteocytes

106
Q

what 3 things occur during bone remodelling in fracture repair?

A
  1. compact bone replaces spongy bone at the bone surface or diaphysis
  2. osteoclasts remove excess bone
  3. bone returns to normal shape
107
Q

what 2 things do long bones have?

A

a shaft (diaphysis) & bone ends (epiphysis)

108
Q

label the bones of the shoulder (pectoral) girdle

A
109
Q

in muscle relaxation what happens when troponin returns to its original shape?

A

tropomyosin blocks actin active sites

110
Q

what is another name for osteogenesis imperfecta?

A

brittle bone disease

111
Q

what does the inner synovial membrane of an articular capsule do?

A

produces synovial fluid

112
Q

do myofibrils extend the entire length of a muscle fibre?

A

yes

113
Q

label the bone

A
114
Q

what is a tubercle?

A

a small rounded projection

115
Q

what is a spine?

A

a pointed (slender, sharp) projection

116
Q

what do you call a fracture where the bone breaks along the epiphyseal plate?

A

epiphyseal fracture

117
Q

what are the 6 general features of a synovial joint?

A
articular capsule
joint (synovial) cavity
synovial fluid
articular cartilage
reinforcing ligament
sensory neurons & blood vessels
118
Q

label the surface feature of the hip bone

A
119
Q

where do osteocytes lie in an osteon?

A

in-between each layer of matrix

120
Q

what do bones do?

A

they form the body’s solid internal framework (skeleton)

121
Q

what 6 movements does a ball & socket joint allow?

A

flexion, extension, adduction, abduction, circumduction & rotation

122
Q

what are the characteristics of bone in a patient with osteoporosis?

A

porous, light, fragile & easily fractured

123
Q

label the surface feature of the skull

A
124
Q

In muscle contraction what happens after an AP is produced produced in the sarcolemma?

A

AP travels along the length of the sarcolemma

125
Q

what is an example of a saddle joint?

A

carpometacarpal joint of the thumb

126
Q

what is the first step of events that lead to muscle contraction?

A

somatic motor output (AP) travels along the axon of a lower motor neuron to the axon terminals

127
Q

what 2 things occur when a bony callus of spongy bone forms?

A
  1. fibrocartilaginous callus is replaced by spongy bone

2. bone ends firmly united

128
Q

what are osteoblasts?

A

bone “building” cells - produce & secrete collagen fibres & ground substance (matrix)

129
Q

what does the endosteum do?

A

covers spongy bone

130
Q

label the contractile unit of myofibrils

A
131
Q

label the diagram of fracture repair

A
132
Q

what is diarthrosis

A

a freely movable joint

133
Q

what is a greenstick fracture?

A

bone bends & cracks - incomplete break

134
Q

what are angular movements?

A

increase or decrease the angle between articulating bones

135
Q

what is the effect of osteoclasts removing old matrix from the inner surface during appositional growth?

A

enlarges medullary cavity & prevents bones from becoming too heavy

136
Q

label the surface feature of the hip bone

A
137
Q

label the surface feature of the vertebra

A
138
Q

what does the periosteum do & what does it contain?

A

covers compact bone

contains blood vessels & nerves

139
Q

what is osteogenesis imperfecta?

A

congenital bone disorder that affects the quantity &/or quality of collagen fibres

140
Q

what are the 5 divisions of the vertebral column & how many vertebrae do they each have?

A

cervical (7), thoracic (12), lumbar (5), sacrum (5), coccyx (4)

141
Q

where does appositional bone growth occur?

A

the outer surface of all bones

142
Q

the pubic symphysis is fibrocartilage true/false

A

true

143
Q

what happens after an AP travels along the axon of a lower motor neuron to the axon terminals in muscle contraction?

A

voltage-gated Ca2+ channels open & Ca2+ enters the axon terminal

144
Q

what 3 things does bone remodelling do?

A
  1. maintain bone mass & strength
  2. replace old matrix with new matrix
  3. involved in bone resorption & bone deposition
145
Q

what 3 movements do synovial joints allow?

A

angular
rotational
special

146
Q

label the surface features of the fibula & tibia

A
147
Q

label the surface features of the humerus

A
148
Q

what is a fracture?

A

any crack or break in a bone

149
Q

what are skeletal muscles innervated by?

A

lower motor neurons

150
Q

label the skeletal muscle structure

A
151
Q

what is the perimysium

A

connective tissue sheath (membrane) that surrounds a bundle (fascicle) of muscle fibres

152
Q

what are joints & what do they do?

A

they are the sites where 2 or more bones meet

facilitate body movement

153
Q

in muscle contraction what happens after an AP travels along the length of the sarcolemma?

A

AP travels down the T tubules deep into the muscle fibre

154
Q

what are 3 examples of cartilaginous joints?

A

first sternocostal joint
pubic symphysis
intervertebral joints

155
Q

who is more susceptible to osteoporosis?

A

females

156
Q

what is a epicondyle?

A

a raised area on or above a condyle

157
Q

what is the first stage of muscle relaxation?

A

ACh within the synaptic cleft if degraded by the enzyme acetylcholinesterase (AChE)

158
Q

what are surface features/landmarks?

A

projections, depressions & openings found on the surface of bones, functions as sites of muscle, tendon or ligament attachment

159
Q

what characteristics do collagen fibres give bone?

A

flexibility & tensile strength

160
Q

label the surface feature of the femur

A
161
Q

what causes osteomalacia (adults) & rickets (children)?

A

caused by insufficient calcium intake or a vit. D deficiency

162
Q

label the long bone

A
163
Q

in muscle relaxation what happens after ACh is degraded by AChE?

A

sarcolemma returns to its resting state (RMP)

164
Q

what are irregular bones?

A

complex shaped bones

165
Q

label the thin myofilament

A
166
Q

what is a malleolus?

A

a projection shaped like a hammer head

167
Q

what makes up muscle & epithelial tissue in bones?

A

blood vessels

168
Q

what are the 2 divisions of the human skeleton?

A

the axial & appendicular skeleton

169
Q

fill in the blank:

origin = the ___ point of muscle attachment

A

the fixed point of muscle attachment

170
Q

is synarthrosis, amphiarthrosis & diarthrosis a functional or structural classification of joints?

A

functional

171
Q

what 3 things occur when a fibrocartilaginous callus forms?

A
  1. fibroblasts produce collagen fibres
  2. chondoblasts produce cartilage
  3. fibrocartilaginous callus splints broken bone ends
172
Q

list 4 examples of a hinge joint

A

elbow, knee, ankle & interphalangeal (finger) joints

173
Q

what are osteocytes?

A

mature bone cells that maintain the matrix

174
Q

label the special movements of a synovial joint

A
175
Q

label the bones of the upper limb

A
176
Q

what type of bones are the sternum, ribs, scapula & skull bones?

A

flat bones

177
Q

how do you functionally describe cartilaginous joints?

A

immovable or slightly moveable

178
Q

what are sarcomeres composed of?

A

contractile proteins called thick & thin myofilaments

179
Q

what do you call a bone fracture where the bone fragments into three or more pieces?

A

comminuted fracture

180
Q

what 3 things occur during epiphyseal plate closure?

A
  1. the rate of bone formation exceeds the rate of cartilage formation
  2. cartilage eventually replaced entirely by bone
  3. epiphyseal plate becomes epiphyseal line
181
Q

what is bone resorption?

A

osteoclasts break down “old” matrix

182
Q

label the muscle fibre

A
183
Q

what do skeletal muscles do?

A

contract to bring about body movements

184
Q

what specialised bone cell is this?

A

osteoprogenitor cell

185
Q

label the bone

A
186
Q

what is this?

A
187
Q

what is synarthrosis, amphiarthrosis & diarthrosis classifications based on?

A

amount of movement of joints

188
Q

fill in the blank:

bones help maintain homeostatic blood ___ levels

regulated by ___ hormone & ___

A

bones help maintain homeostatic blood calcium levels

regulated by parathyroid hormone & calcitonin

189
Q

each osteon runs perpendicular to the long axis of a bone (true/false)

A

false - runs parallel

190
Q

what do axon terminals of lower motor neurons form with a muscle fibre?

A

neuromuscular junction (synapse)

191
Q

in muscle contraction what happens after Ca2+ flows into the cytoplasm of the muscle fibre?

A

binding of Ca2+ to troponin pulls tropomyosin away from the actin active sites

192
Q

what do muscle tendons do in synovial joints?

A

stabilise joint

193
Q

what are 2 examples of condylar joints?

A

metacarpophalangeal (knuckle) & wrist joints

194
Q

what is another name for joints?

A

articulations

195
Q

label the bones of the pelvic girdle

A
196
Q

what do you call a fracture caused by a disease that weakens bone structure?

A

pathological fracture

197
Q

what are osteoclasts?

A

bone “resorbing” cells that break down the matrix & release stored minerals

198
Q

label the joint (articular) surfaces on the humerus

A
199
Q

what is a process?

A

a bony prominence (bump)

200
Q

what is the role of trabeculae in spongy bone?

A

precisely orientate to resist forces from all directions & transfer weight without breaking

201
Q

label the diagram of fracture repair

A
202
Q

what does a pivot joint allow?

A

rotation

203
Q

what is osseous tissue?

A

connective tissue - contains specialised cells & an extracellular matrix

204
Q

in muscle relaxation what happens after Ca+ release channels in the SR close?

A

Ca+ ions actively pumped back into the SR

205
Q

what specialised bone cell is this?

A

osteoblast

206
Q

what are 2 examples of plane joints?

A

intercarpal & intertarsal joints

207
Q

fill in the blank:

bones produce ___ ___ cells, ___ ___ cells & ___ (haematopoiesis)

A

bones produce RBC, WBC & platelets

208
Q

what is the effect of osteoblasts secreting layers of new matrix onto the bone surface during appositional growth?

A

becomes compact bone & the bone widens

209
Q

describe the connective tissue in fibrous joints

A

fibrous connective tissue unites articulating bones

210
Q

what are the 2 steps in appositional bone growth?

A
  1. osteoblasts secrete layers of new matrix onto the bone surface
  2. in long bones, osteoclasts slowly remove old matrix from inner surface
211
Q

what makes up nervous tissue in bones?

A

sensory neurons

212
Q

what are bursae & tendon sheaths & what is their function?

A

bags of synovial fluid

reduce friction between adjacent joint structures

213
Q

during muscle contraction what happens after ACh binds to nicotinic receptors on the sarcolemma?

A

ion channels open
influx of Na+ ions
sarcolemma depolarises
GP produced

214
Q

what determines the type of movement allowed by a synovial joint?

A

shape of the articulating surfaces

215
Q

what are 4 additional structures of a synovial joint?

A

menisci
muscle tendons
bursae & tendon sheaths
fat pads

216
Q

define synarthrosis

A

immovable joint

217
Q

during childhood what 2 hormones control bone growth?

A

growth hormone (GH) & thyroid hormone (TH)

218
Q

the epiphyseal plate is what type of cartilage?

A

hyaline

219
Q

do cartilaginous joints have a joint cavity?

A

no

220
Q

label the surface feature of the hip bone

A
221
Q

what are 2 examples of fibrous joints?

A

sutures

tibiofibular joint

222
Q

what 5 movements do saddle joints allow?

A

flexion, extension, adduction, abduction & circumduction

223
Q

do bones have normal matrix components in osteoporosis patients?

A

yes, but in reduced amounts

224
Q

what does cartilage do?

5

A
supports body structures
connects bones
maintains the shape of body structures
resists compression
has tensile strength
225
Q

what do ligaments do?

A

connect the articulating bones at a joint

226
Q

the site of muscle attachment to a bone can be known as 2 things, list them

A

the origin or insertion

227
Q

what do tendons do?

A

connect muscles to bone

228
Q

what is a closed (simple) fracture?

A

broken bone does not break the skin

229
Q

what do you call a bone fracture where there is a break at the distal end of the radius?

A

colles fracture

230
Q

what specialised bone cell is this?

A

osteoclast

231
Q

what connective sheath (membrane) surround each individual muscle fibre?

A

endomysium

232
Q

what is a tuberosity?

A

a round roughened projection

233
Q

what breaks the attachment of myosin & actin?

A

ATP

234
Q

label the diagram of fracture repair

A
235
Q

in muscle contraction what happens after the AP travels down the T tubules deep into the muscle fibre?

A

AP stimulates sarcoplasmic reticulum Ca2+ release channels open

236
Q

how do you classify a slightly movable joint?

A

amphiarthrosis

237
Q

what is a pott’s fracture?

A

a break in the medial malleolus of the tibia &/or lateral malleolus of the fibula

238
Q

what type of bone are the humerus & clavicles?

A

long bone

239
Q

what are the characteristics of bones in osteogenesis imperfecta?

A

brittle, easily fractured

240
Q

what does the extracellular matrix consist of in osseous tissue?

A

ground substance, collagen fibres, & calcium phosphate crystals

241
Q

what are fat pads & what are their function?

A

mass of adipose tissue

cushion & protect joint structures

242
Q

what are these joints an example of?

A

synovial joints

243
Q

is there a cure for osteogenesis imperfecta?

A

no

244
Q

articular cartilage is what type of cartilage?

A

hyaline

245
Q

what are osteoprogenitor cells?

A

stem cells that differentiate into osteoblasts

246
Q

what is the function of the bones of the shoulder (pectoral) girdle?

A

attach the upper limbs to the axial skeleton

247
Q

what is osseous tissue arranged into?

A

osteons

248
Q

what does a reinforcing ligament do in a synovial joint?

A

stabilises joint

249
Q

what is the musculoskeletal system comprised of?

6

A

bones, skeletal muscles, tendons, joints, ligaments, & cartilage

250
Q

what goes the tough outer fibrous layer of an articular capsule do?

A

stabilises articulating bones

251
Q

label the bones of the lower limb

A
252
Q

based on connective tissue that connects the articulating bones & the presence/absence of a joint cavity, what can joints be structurally classified as?

A

fibrous
cartilaginous
synovial

253
Q

list 2 examples of minerals that bones store

A

calcium

phosphate

254
Q

during adolescence what 3 hormones are required in males & what 3 hormones are required in females?

A

growth hormone (GH), thyroid hormone (TH), testosterone (males) & oestrogen (females)

255
Q

describe the cartilage in synovial joints

A

articulating bone ends are covered in articular cartilage

256
Q

label the 6 general features of a synovial joint

A
257
Q

what 3 things occur when a haematoma forms?

A
  1. torn blood vessels haemorrhage
  2. clot forms
  3. site swollen & sore
258
Q

what are the 4 major stages of fracture repair?

A
  1. haematoma forms
  2. fibrocartilaginous callus forms
  3. bony callus of spongy bone forms
  4. bone remodelling
259
Q

what type of cartilage is the intervertebral disc?

A

fibrocartilage

260
Q

what connective tissue sheath (membrane) surrounds the entire skeletal muscle?

A

epimysium