Workbook questions session 1 & 2 Flashcards

1
Q

Can cartilage be converted into bone? Explain. (3marks)

A

No. Cartilage can be replaced by bone. Cartilage (cartilage matrix) can become calcified thus restricting nutrient and gaseous supply to chondrocytes; chondrocytes thus die. Osseous tissue can be laid on the surface of the calcified matrix, eventually replacing all cartilage by bone.

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2
Q

What factors are responsible for the appearance of tuberosities, tubercles, ridges and grooves on a typical long bone?

A

Tuberosities, tubercles and ridges – mechanical forces resulting from attachment of muscles, tendons and ligaments to bone.

Grooves – pressures from adjacent structures e.g. nerves and blood vessels

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3
Q

State the mechanical functions of bones?

A

Provide the rigid framework that supports the body.
Protect vulnerable internal organs (e.g. brain, heart, lungs, etc.).

Make body movements possible by providing anchoring points for muscles and by acting as levers at the joints.

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4
Q

Briefly, what is the function of red bone marrow and erythropoietin? (2 marks)

A

Production of erythrocytes (erythropoiesis) occurs in red bone marrow.

Erythropoietin is released from the kidney when blood oxygen levels are low (e.g., anaemia) to stimulate red blood cell production

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5
Q

Concerning the functional classification of joints, define the terms; synarthrosis, amphiarthrosis and diarthrosis.

A

By classification, a joint may be immovable (synarthrosis), slightly movable (amphiarthrosis) or freely movable (diarthrosis).

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6
Q

Joints may also be classified by their structure name the three classification and give examples of each.

A

Synovial - characterised by ends of bone covered by cartilage & fluidity in cavity e.g. shoulder, knee

Fibrous joints – sutures (tight union between bones of the adult skull) syndesmoses (bones held together by fibrous tissues – interosseous membrane between long bones of the forearm & leg)

Cartilaginous joints – primary cartilaginous (epiphyseal growth plate in long bones) secondary cartilaginous (disc of fibrocartilage in the joint cavity e.g. pubic symphysis, intervertebral joint).

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7
Q

What are the three main components of all synovial joints?

A
  • Articular surfaces cornered by hyaline cartilage, separated by joint cavity
  • Synovial membrane (lining cavity) that secretes synovial fluid
  • Protective capsule surrounds joints.
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8
Q

What are the factors that restrict movement at synovial joints? (3)

A

Tension exerted by ligaments of the articular cartilage (e.g. iliofemoral ligament of hip).

Muscle tension (thigh difficult to raise when knee is straight – stretched hamstrings)

Interference by other structures. Stability at joints is also related to the depth of bony articulations.

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9
Q

Which specific tissues of joints are affected in rheumatoid arthritis and osteoarthritis?

A

RA= Synovium

OA = Cartilage

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10
Q

Concerning the bones of the pectoral girdle and the upper limb, name one bone that develops by intramembranous ossification and one bone that develops by endochondral ossification.

A

clavicle

humerus, respectively.

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11
Q

What is the basic difference between intramembranous and endochondral
ossification?

A

Intramembranous – develops directly from mesenchymal tissue

Endochondral – develops by replacing hyaline cartilage model.

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12
Q

What are the three types of bone cells and for each state their function?

A

Osteoblasts are bone-forming cells (secrete collagen to form a matrix which is calcified)

Osteocytes are former osteoblast cells that become encased in the bone matrix, forming tight junctions with each other across the matrix.

Osteoclasts are bone-breaking cells (resorb bone).

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13
Q

90% of our total body calcium is contained in all bones, and they are therefore a reserve for calcium and other compounds (such as inorganic phosphates). Very generally, why is hypocalcaemia or hypercalcaemia dangerous?

A

Small decreases of calcium in plasma and extracellular fluid (hypocalcaemia) can cause the nervous system to become more excitable because of increased neuronal membrane permeability with resultant muscular spasm.

Too much calcium (hypercalcaemia) in body fluids depresses the nervous system and causes muscles to become sluggish and weak because the effects of calcium on muscles’ plasma membranes. Bones represent a calcium store for homeostasis.

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14
Q

Write brief notes on the action of parathyroid hormone and calcitonin on bone and state what stimulates their release.

A

Parathyroid hormone (PTH) and calcitonin (CT) have direct effects on bones. PTH released from the parathyroid glands in response to low calcium levels in the blood stimulates the uptake of calcium from bone, kidneys and the intestinal tract to return calcium levels to normal. PTH increases the number and activity of osteoclasts in bone to increase calcium (and phosphate) resorption from bone and stimulate release of the minerals into blood.
CT is released from specific thyroid cells (parafollicular cells) in response to elevated calcium levels in the blood. CT causes calcium levels to be lowered by inhibiting osteoclastic activity in bone; it also favours calcium uptake by bone, promoting bone formation and decreasing blood calcium levels.
PTH increases blood calcium, while CT lowers it.
(Human growth hormone, thyroid hormones, sex hormones, adrenal cortical hormones and vitamins A,C and D are also important in bone function.

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15
Q

State how nutritional deficiency of the following compounds may affect bone.

A
i) Calcium / phosphorous 
Proper nutrition (calcium and phosphorus constitute almost half the content of bone) is essential for normal bone development and maintenance; thus their deficiency causes bones to become brittle.

ii) Vitamin A
Deficiency in vitamin A may cause an imbalance in the ratio of osteoblasts and
osteoclasts, thereby slowing the growth rate.

iii) Vitamin C
Low levels of vitamin C inhibit growth by causing an insufficient production of collagen and bone matrix, a condition that delays the healing of broken bones.

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16
Q

Explain the cause of osteomalacia in the adult and rickets in children.

A

growth plate is affected and the bones may easily become deformed. Osteomalacia and rickets are defects skeletal resulting from vitamin D deficiency. This leads to widening of the epiphyseal plates, increased number of cartilage cells, wide osteoid seams and decrease in linear growth. Rickets is a childhood disease caused by insufficient mineralisation.
In children with highly pigmented skin and others whose body surfaces are not exposed to sunlight, absorption of ultra-violet rays is markedly affected; ultra-violet rays are involved in vitamin D formation; skeletal deformities such as bowed legs, knock-knees, etc. are common. Osteomalacia leads to demineralisation, an excessive loss of calcium and phosphorus; this condition can be reversed with large doses of vitamin D.

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17
Q

Explain briefly the cause of osteoporosis in post-menopausal women with reference to female reproduction hormones

A

After menopause, the ovaries produce little oestrogen; low oestrogen affects older bone by destroying it faster than the formation of new bone. Bone mass decreases and it becomes porous and brittle.

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18
Q

Explain how do bisphosphonates and calcitonin provide therapy to those with osteoporosis?

A

Both inhibit osteoclast activity. Calcitonin can also stimulate osteoblast activity and favours calcium uptake into bone

19
Q

Briefly describe the main features of Paget’s disease? (

A

This is a progressive bone disease in which a pattern of excessive bone destruction is followed by bone formation contributing to thickening of bones. This deformity usually involved the skull, pelvis and lower extremities and occurs after the age of 40 and is typical in the 60’s.

20
Q

What are the 6 types of synovial joint - give examples (& have a look at pictures)

A

Ball and socket (permit movement on several axis) - shoulder & hip

Plane (permit gliding or sliding) - acromioclavicular joint

Hinge (permit flexion & extension only) - elbow joint

Saddle (concave and convex surfaces) - sternoclavicular

Pivot (allow rotation) - Distal & Proximal radioulnar joints

Condyloid (permit flexion & extension, adduction & abduction, & circumduction) - wrist joint

21
Q

Name two long bones

A

Humerus, radius, ulna or metacarpals

22
Q

one irregular bone

A

Carpal bones

23
Q

one flat bone

A

Scapula,

24
Q

one sesamoid bone

A

Pisiform

25
Q

Identify precisely the structures in the axilla when compressed by the coracoid process.

A

From anterior to posterior; subclavian vein (½), subclavian artery (½), cords (½) of the brachial plexus (½).

26
Q

In general terms, what are the causes of pain, numbness and tingling sensations (paraesthesia) in the arm? (2 X ½ marks)

A

Neurological signs and symptoms such as pain running down the arm,
numbness and paraesthesia result from compression of nerves (½) and axillary vessels. (½)

27
Q

What is cyanosis? (1 mark) Explain the cyanosis and venous distension of veins in the patient’s right arm. (1 mark)

A

from the build-up of deoxygenated haemoglobin (1). Compression of the axillary vessels causes ischaemia of the arm and distension of the superficial veins. (1)

28
Q

Explain, with reference to the anatomy, the cause of weakness of the right radial pulse. What do you expect to feel when palpating the right ulnar pulse?

A

Compression of the subclavian artery has compromised blood supply to the upper limb.
The subclavian artery continues as the axillary artery (½) and in turn the brachial artery (½). The brachial artery divides in the lower part of the cubital fossa (½) into the radial and ulnar arteries. As blood supply to both radial and ulnar arteries carries comes via the subclavian artery, both radial and ulnar pulses will be weak (½).

29
Q

State the actions of pectoralis major and the pectoralis minor and name their nerve supply.

A

Pectoralis major = Adducts, flexes and medially rotates the arm. (1) all are required.

Pectoralis minor = Depresses shoulder tip. (1)

Both are supplied by the medial and lateral pectoral nerves. (1)

30
Q

What process, within the muscle fibre, causes skeletal muscle relaxation?

A

The active transport of calcium ions back into the sarcoplasmic reticulum.

31
Q

Explain How does an increase in intracellular calcium produce symptoms of muscle rigidity?

A

An increase in intracellular calcium activates the crossbridge cycle promoting contraction. The sustained release of calcium counteracts the process of re-uptake of calcium back into intracellular stores necessary for relaxation.

32
Q

Since skeletal muscle comprises more than 35% of the body mass, an increase in the metabolic activity of skeletal muscles during contraction causes a significant increase in body temperature. List three other clinical signs of a large increase in body metabolism.

A

Fall in blood oxygen, rise in blood carbon dioxide, fall in blood pH, tachycardia, increased ventilation, etc. Blood vessel compression due to muscular rigidity impairs blood flow and contributes to the changes in blood gas levels.

33
Q

The axilla contains the fibrous axillary sheath. Name the structures are contained within the axillary sheath?

A

Axillary artery, axillary vein and cords & branches of the brachial plexus.

34
Q

Abduct an upper limb to 45°. With your other hand palpate the anterior and posterior axillary fold, which muscles form the anterior and posterior folds the axilla?

A

Anterior wall – Pectoralis major mostly (palpable) (& pectoralis minor, more superiorly, add to the anterior wall)

Posterior wall –Teres major & latissimus dorsi, (Subscapularis and the scapula contribute to the posterior wall of the axilla more superiorly)

35
Q

Which muscles form the medial wall of the axilla?

A

Intercostal muscles and (the overlying) serratus anterior

36
Q

In a female patient, explain why would you be concerned about enlargement of lymph nodes in the axilla?

A

The axillary lymph nodes receive lymph from the breast; in cancer of the breast, cancerous cells may enter the lymph vessels and pass to the axilla lymph and may produce enlargement of axillary lymph nodes.

37
Q

Name the nerves that supply flexor muscles of the arm and the forearm.

A

Musculocutaneous, radial, median and ulnar

38
Q

The lateral, medial and posterior cords of the brachial plexus are named with respect to an important blood vessel. Name this vessel.

A

Axillary artery

39
Q

Which important blood vein lies immediately posterior to the sternoclavicular joint?

A

Brachiocepalic vein

40
Q

What do you think is the function of the clavicle? Explain what would happen to the position of the arm and clavicular fragments in the event of a fracture of the clavicle?

A

The clavicle acts as a strut (rigid support) from which the scapula and the upper limb are suspended and keeps them away from the thorax (allowing the arm to have maximum freedom of motion).
When the clavicle fractures, the sternocleiodomastoid muscle elevates the medial segment; because the trapezius muscle is unable to hold the lateral segment up and because of the weight of the upper limb, the shoulder drops and the arm is pulled medially by the adductor muscles of the arm.

41
Q

During a RTA (road traffic accident), a young man fractured his right clavicle. The jagged end of the lateral half of the clavicle plunged backwards briefly. At the emergency clinic, the patient was seen to be supporting his right upper arm with his left hand.

Comment on the position of the lateral clavicular fragment fragment with reference to the fact that he is now supporting his right upper limb with his left hand.

A

also lie inferiorly ( ½ ).
The medial pull is due to the action of pectoralis major muscle adducting the upper limb ( ½ ).
The more inferior position of the clavicle relates to the fact that the fractured clavicle can no longer support the upper limb ( ½ ) now pulling it down, hence, the man supports it with his left arm.

42
Q

Which parts of the brachial plexus are at most risk to injury as a result of a clavicular fracture i.e. which parts lie immediately posterior to the usual fracture point of the clavicle?

A

Trunks and divisions of brachial plexus.

43
Q

Consider patient safety. What is the best way to assess damage to these nerves?

A

Sensory: test peripheral innervation (hand and forearm) of the following nerves
radial
ulnar
median
musculocutaneous (continues as lateral antebrachial cutaneous nerve)

Motor: definitely no testing. Will cause more damage and pain,

44
Q

In the event of bleeding from a large vessel as a result of the fracture, how would you determine whether an artery or a vein has been ruptured?

A

Subclavian artery: may show pulsatile release of blood from an open wound, but damage to such a major artery the patient would most likely be unconscious and dying!

Subclavian vein: Non-pulsatile, patient conscious, haematoma forming if not an open wound