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Phase 1 > MSK: Week 2 > Flashcards

MSK: Week 2 Flashcards

1
Q

Role of osteoblasts during bone turnover

A

They add new bone tissue - Ossification

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2
Q

Role of osteoclasts during bone turnover

A

They resorb mature bone tissue from the skeleton

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3
Q

What two things to osteoclasts secrete into the extracellular matrix

A 
Proteolytic enzymes
Several acids (citric acid + lactic acid)
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4
Q

Where is lactic acid and citric acid produced in the osteoclasts

A

Mitochondria

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5
Q

Why do osteoclasts secrete proteolytic enzymes and acids

A

To break down the organic matrix

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6
Q

How do osteoclasts take in broken down bone matrix and crystals

A

Phagocytosis so they are moved into the blood

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7
Q

What two ways do osteoclasts and osteoblasts communicate with each other to regulate bone turnover rates

A

Coupling: Bone formation occurs at the site of previous bone resorption

Balance: Amount of bone removed by osteoclasts should be replaced by osteoblast activity

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8
Q

Where are osteoclasts derived from

A

Myeloid progenitor cells

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9
Q

What are cytokines involved in

A

Inflammatory and infectious diseases

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10
Q

What are two properties of cytokines

A

Redundancy

Pleiotroptism

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11
Q

Define redundancy

A

Most of the functions of cytokines can be performed by many different cytokines

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12
Q

Define pleiotropism

A

A single cytokine has many different functional effects on many different cell types

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13
Q

Define a hormone

A

Released from organs into the blood

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14
Q

Define a neurotransmitter

A

Released by nerves

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15
Q

Define autocrine

A

If a cytokine acts on the cell that secretes it

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16
Q

Define paracrine

A

If the action is restricted to the immediate vicinity of a cytokine’s secretion

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17
Q

Define endocrine

A

If a cytokine diffuses directly into the blood and is transported to different regions of the body

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18
Q

What four hormones mediate the action of osteoclasts

A

1,25(OH)2D
PTH
Oestrogen
Leptin

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19
Q

What is the role of OPG

A

Prevent resorption by osteoclasts by binding to RANK-Ligand receptors

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20
Q

What are four functions of Ligaments

A

Attach bone to bone
Increase mechanical strength of joints
Guide joint motion
Prevent excessive motion

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21
Q

What are five functions of tendons

A 
Connect muscle to bone (insertions)
Aid joint stability 
Stabilise joints
Enable joint motion
Interact with ligaments to regulate load exerted on them
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22
Q

Why are fibres in tendons and ligaments arranged in parallel fibres

A

Enables tissue to sustain high tensile strengths

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23
Q

What cells are found in tendons and ligaments that modify the extracellular matrix

A

Fibroblasts (tenocytes)

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24
Q

What is the consequence of a decrease in fibroblast numbers

A

Causes low turnover rate and poor capacity for healing

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25
Q

How much of tissue volume do fibroblasts make up (percentage)

A

20%

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26
Q

What percentage of tissue volume is made up by Extracellular matrix

A

80%

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27
Q

How much of the ECM is made up of water

A

70%

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28
Q

How much of the ECM is mad up of solids

A

30%

These are collagen and ground substances

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29
Q

Describe the vascularisation of tendons and ligaments

A

They are sparsely vascularised

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30
Q

What is the consequence of ligaments and tendons being sparsely vascularised

A

Poor, slow capacity for healing

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31
Q

Describe the structure of tendons and ligaments

A

Look in book

Outer layer is called epitenon

Layer surrounding fascicles is known as endotenon

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32
Q

What type collagen are tendons and ligaments mainly composed of

A 
Type I
Type III (small amounts)
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33
Q

Why do tendons and ligaments have proteoglycans

A

Provide lubricant to allow collagen fibres to move over each other + Regulate fibre diameter

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34
Q

What cell produces collagen and in what form are they produced as

A

Fibroblasts as procollagen (it is modified to collagen in the ECM)

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35
Q

How does the amount of elastin in tendons and ligaments differ when they differ in function at different parts of the body

A

Little elastin in tendons and extremeity ligaments

Loads present in ligaments supporting the spine (e.g. ligamentum flavium)

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36
Q

Role of ligamentum flavium

A

Protects spinal nerve roots

Needed for spine stability

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37
Q

Ligament vs Tendons (4)

A

Ligaments connect bone to bone vs Tendons connect bone to muscle

Ligaments have less collagen I (90% of dry weight) vs Tendons have more collagen I (95%)

Ligaments have more elastic content vs Tendons have less elastic content

Ligaments fibre organisation is random vs tendon fibre organisation is highly organised

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38
Q

Describe the blood supply of tendons and ligaments

A

Where they are surrounded by paratenon, they have vascular blood supply

Where they are surrounded by a tendon sheath, they are avascular and receive oxygen via simple diffusion from neighboring tissues

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39
Q

What is enthesis

A

Insertion of a tendon or ligament to a bone

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40
Q

What are the two types of insertions we can have?

A

Fibrous

Fibrocollagenous

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41
Q

WHat receptors do places of insertion have

A

Pain and proprioceptive receptors

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42
Q

What are fibrous insertions

A

Formed through intramembranous ossification (anchorage by sharpey fibres onto a bone)

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43
Q

What are fibrocartilage insertions

A

Gradual change form collagenous ligaments to fibrocartilage and then to mineralised cartilage onto a bone

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44
Q

What are fibrocartilage insertions formed through

A

Endochondral ossification

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45
Q

What does tensile load on ligaments and tendons result in

A

Results in elongation of the ends of the tissue

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46
Q

What does compressive load on ligaments and tendons result in

A

Contraction between the ends of the tissue

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47
Q

Describe the load-elongation curve

A
  1. Small increase in load as crimpled collagen fibres straighten
  2. Linear region fibres straighten and stiffness increases rapidly with loading
  3. Maximum deformation and tensile strength of tissue. After this, collagen fibres begin to fail (Pmax)
  4. Complete failure of tissue to support load
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48
Q

Is Pmax usually achieved during normal activity

A

No - 30% of it is achieved

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49
Q

Describe the load-elongation curve of ligaments such as ligamentum flavum that have high elastin content

A

Elongation increases exponentially with load

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50
Q

What is the ligamentum flavum connected to

A

Laminae to adjacent vertebrae

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51
Q

How does age affect mechanical properties of ligaments and tendons

A

Up to 20: - Increased number + quality of cross-links between collagen molecules = Increased tensile strength
- Increased collagen fibril diameter = Increased tensile strength

Aging: Decreased collagen content = decreased tesile strength

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52
Q

How does pregnancy affect strength of ligaments and tendons

A

Decreased tensile strength due to hormones

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53
Q

How does physical training affect tendon and ligament strength

A

Increased tendon tensile strength

Ligaments become stiffer and stronger as collagen fibres increase in diameter

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54
Q

How does immobilisation affect tendon and ligament strength

A

Decreased tensile strength of ligaments, more elongation and less stiff
Decreased cross-links

NOTE: It takes months to recover strength after weeks of immobilisation

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55
Q

Outline the phases of tendon and ligament repair after injury

A 
Short-term inflammatory phase (days)
Proliferative phase (weeks)
Remodelling and maturation phase (months)
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56
Q

How does repaired tendon compare with the original tendon we had before the injury

A

It will be a lot weaker even years after injury.

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57
Q

What are three functions of joints

A
  1. Provide movement in three dimensions
  2. Weight-bearing
  3. Transfer load evenly to the MSK system
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58
Q

Define ‘structural classification’ of joints

A

Joints classified by the degree of movement they allow

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59
Q

Define the ‘functional classification’ of joints

A

By the components/tissues that hold the joints together

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60
Q

Name the three main types of structural joints

A
  1. Fibrous
  2. Cartilaginous
  3. Synovial
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61
Q

Name the three main types of functional joints

A
  1. Synarthroses (immovable joints)
  2. Amphiarthroses (Slightly moveable joints)
  3. Diarthroses (Freely moveable joints)
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62
Q

Where are synarthroses found?

A

Skull sutures

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63
Q

What do amphiarthroses mostly consist of

A

Mostly cartilaginous

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64
Q

What do diarthroses consist of

A

Synovium

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65
Q

What are skull sutures

A

Interdigitating adjacent bone

Junction filled with short tissue fibres

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66
Q

Why do we need skull joints

A

To allow the growth of the skull after birth

67
Q

What happens to the fibrous tissue between skull bones once growth has stopped

A

Forms bone sutures

68
Q

What are syndesmoses

A

Fibrous joint - Bones connected by a cord or sheet of fibrous tissue

69
Q

What affects the amount of movement of syndesmoses

A

Length of the fibre

70
Q

What is an example of syndesmoses

A

Interosseous membranes

71
Q

What type of joint are gomphoses

A

Fibrous joints

72
Q

Where are Gomphoses found

A

In tooth articulation as a plug in socket joint

73
Q

What type of joint are synchondioses

A

Connection of bone via hyaline cartilage

74
Q

Are joints of synchondioses moveable

A

Yes

75
Q

What is an example of synchondioses

A

Costal cartilage of ribs

76
Q

What type of joint are symphysis

A

Connecting cartilage is a pad or plate of fibrocartilage

77
Q

Where can symphysis be found

A

At the spinal cord

78
Q

What category of joints do suture, syndesmosis and gomphosis lie under

A

Synarthrosis - Fibrous

79
Q

What category do synchondrosis and symphysis lie under

A

Amphiarthrosis - Cartilaginous

80
Q

What are synovial joints

A

Where articulating bones are separated by a fluid-filled cavity

81
Q

What are the most common joints in the body

A

Synovial joints

82
Q

What are the five properties of synovial joints

A
  1. Articular cartilage
  2. Joint Capsule - Inner Layer is synovial membrane
  3. Joint Cavity - A space filled with synovial fluid
  4. Synovial Fluid
  5. Reinforcing Ligaments
83
Q

What are two other structures found in knee joints (which are also synovial but have other components to normal joints)

A
  1. Bursae

2. Menisci

84
Q

What are bursae

A

Fluid-filled sacs lined by synovial fluid

85
Q

What are menisci

A

Discs of fibrocartilage

86
Q

What are five properties of hyaline cartilage

A
  1. Frictionless Surfaces
  2. Resists compressive loads
  3. High Water content
  4. Low cell content
  5. No blood supply
87
Q

What three important substances are found in the cartilage

A

Water, proteoglycans and collagens

88
Q

Why is hyaline cartilage so important

A
  1. Acts as a shock absorber to protect bones during joint movement
  2. Provides smooth, frictionless surface for movement
89
Q

Describe the layers of hyaline cartilage

A
  1. Superficial Zone
  2. Intermediate Zone
  3. Deep Zone
  4. Calcification of bone
  5. Subchondral bone
90
Q

What is synovial fluid

A

Joint lubricant

91
Q

How does synovial fluid work

A
  1. Covers articulating surfaces with a thin film
  2. Modified from plasma by synoviocytes
  3. Fluid, proteins + charged sugars that bind to water
  4. Results in slimy fluid
  5. Reduces friction durinng articulation
92
Q

Where is the synovial membrane located

A

On the joint capsule + encloses synovial cavity

93
Q

How thick is the synovial membrane

A

Once or two cells thick

94
Q

What is the role of the synovial membrane and what feature of the synovial membrane allows this to be effective

A

Secretion of synovial fluid components and has villi projections to increase SA

95
Q

What is the first class lever system

A

Fulcrum in the middle with force at one end and resistance at the other end

E.g. Triceps is the force
Elbow is fulcrum
Resistance is a weight being pulled

96
Q

What is the second class lever system

A

Fulcrum is at one end, resistance in the centre and force at the other end

E.g. Temperomandibular joint - Force
Resistance = Muscles attached to coracoid process

97
Q

What is the third class lever system

A

Fulcrum at one end
Force at the middle
Resistance at other end

E.g. Biceps and elbow

98
Q

Where can hinge joints be found

A

Elbow

99
Q

Where can condyloid joints be found

A

Interphalangeal joints

100
Q

Role of condyloid joints

A

Allow flexion, extension, abduction, adduction and circumduction

101
Q

Where can gliding joints be found

A

Carpal bones

102
Q

Role fo gliding joints

A

The bones can slide past each other in any direction

103
Q

Where can saddle joints be found

A

Carpometacarpal joints

104
Q

What is the saddle joint close in function to

A

Condyloid joints

105
Q

What is the role of saddle joints

A

Flexion, Extension, Adduction, Abduction and circumduction - HOWEVER NO AXIAL ROTATION

106
Q

Where can pivot joints be found

A

Spinal cord - Intervertebral discs

107
Q

What join are pivot joints close in function to

A

Hinge joint

108
Q

Define Inversion and Eversion

A

Inversion is the inwards rotation of the foot

Eversion is the outwards rotation of the foot

109
Q

Define dorsi-flexion

A

Movement of foot upwards

110
Q

Define plantar-flexion

A

Downward movement of foot

111
Q

What are the three main stabilising ligaments of the hip joint

A

Iliofemoral
Ischiofemoral
Pubofemoral

112
Q

What are the main stabilising ligaments of the shoulder

A

Glenoidal labrum
Coracohumeral
Three glenohumeral ligaments
Transverse humeral

113
Q

What are the two tendons that stabilise the shoulder

A

Long head of biceps

Rotator cuff muscles

114
Q

What type of joint is present between the femur and tibia

A

Condyloid

115
Q

What type of joint is present between the femur and patella

A

Gliding

116
Q

What type of joint is found between the humerus and ulnar

A

Hinge

117
Q

What type of joint is present between the humerus and radius

A

Gliding

118
Q

What does a molecule of purine consist of

A

A pyramidine ring

An Imidazole ring

119
Q

Is purine water-soluble

A

Yes

120
Q

How can we obtain purines in food

A

Meat

121
Q

What two ways can purines be excreted by the body

A

Urine

Gut

122
Q

How is guanine metabolised

A
  1. Nuclease frees guanine nucleotide
  2. Nulceotidase creates guanosine
  3. Phosphorylase convertes guanosine to guanine
  4. guanase converts guanosine to guanine
  5. Guanase converts guanine to xanthine
  6. Xanthine oxidase oxidises xanthine to uric acid
123
Q

How is Adenine metabolised

A
  1. Nuclease frees nucleotide
  2. Adenosine -> Inosine
  3. Inosine -> hypoxanthine
  4. hypoxanthine -> Xanthine via Xanthine Oxidase
  5. Xanthine -> Uric Acid
124
Q

Where is the uric acid excreted

A

Kidneys

125
Q

Name some sources of purines in the diet

A 
Meat
Offral (heart, liver and kidneys)
Seafood (muscles)
Fish (sardines)
Oatmeal
Fructose
126
Q

What are some risk factors for gout

A 
Obesity 
Raised Temperature
Raised blood pressure
Coronary heart disease
Diabetes
127
Q

Can alcohol increase risk of gout

A

Only in excess - fine in moderation

128
Q

How can I manage gout without medication

A

Rest
Ice pack
Elevate affected joint

129
Q

How can I manage gout with medication

A

NSAIDs
Colchicine
Steroids

130
Q

What are three advice we should give to patients at risk from gout

A

Lose weight
Avoid purine-rich food
Reduce alcohol intake

131
Q

How does allopurinol prevent gout

A

Stops Xanthine Oxidase from working so no Xanthine is produced caused no uric acid production

132
Q

What are three complications of gout

A
  1. Damage to joints
  2. Secondary Infections
  3. Nerve Damage
133
Q

What is a consequence of high uric acid conc.

A

Formation of urate crystals

134
Q

What are two major consequences of increased turnover rates of purines

A
  1. Malignant tissue growing

2. Increased tissue breakdown

135
Q

What happens to uric acid in some organisms

A

Converted to allantoin via urate-oxidase enzyme (not in humans)

136
Q

Why is allantoin production a thing

A

Because allantoin is more water-soluble than uric acid so is more easily excreted in the urine

137
Q

Define Hyperuricemia

A

Over production or under excretion of uric acid

138
Q

Name four type of purines

A

Adenine
Guanine
Hypoxanthine
Xanthine

139
Q

How does excersise affect the strength of the skeleton

A

Increases it

140
Q

Is the change in skeleton strength environmental or genetic

A

Environmental only

141
Q

What happens to the bone when I place a force on it

A

Minor deformation

142
Q

What is strain

A

Change in length / Original Length

143
Q

What are customary strains

A

Strains that the bone is already used to

144
Q

What happens if there is a force exerted on the bone that is greater than customary strain

A

We will have bone formation

145
Q

What happens if force exerted on a bone becomes less than the customary strain

A

Bone loss

146
Q

What factors affect bone strain

A

Magnitude
Rate At which load is added and removed
Frequency of strain exerted
Dwelling of the strain (how long it remains for)
Number of cycles (least important factor)

147
Q

Does duration of physical activity affect bone mass efficiently

A

Nope - It’s not a very large influence

148
Q

Define customary strain stimulus

A

Customary strains that are influenced by magnitude, frequency, duration and rest periods

149
Q

What has the greatest impact on skull strain, smiling, cheqing or walking

A

Smiling

150
Q

Define specific site customary strain stimulus

A

Customary strains that are influenced by magnitude, frequency, duration and rest periods AND that the same load can have different impacts of strain at different parts of the skeleton

151
Q

What four non-force factors can affect strength of the bone

A

Sex
Age
Biochemicals
Drugs

152
Q

Is compression of bone the only way bone strength can increase

A

No, can also increase when bone is stretched (e.g. when monkeys swing from trees)

153
Q

What is the relationship between muscle and bone during excersise

A

An increase in cross-sectional surface of muscle also sees an increase in bone strength

154
Q

How many cycles of strain a day will bones respond to

A

Only two

155
Q

Excersise in the previous how many hours will increase response to subsequent loading

A

4 hours

156
Q

How long does the mechanical load need to be exerted to cause a response in bones

A

BRIEF mechanical load

157
Q

How does rest influence bone strengthening

A

Increases effort by bones to increase in strength

158
Q

What two cells respond to bone loading

A

Osteoblasts and osteocytes

159
Q

When are osteoblasts and osteocytes activated

A

When loading takes place

160
Q

Where are osteoblasts activated

A

Periosteum

161
Q

At what stage in life is response to excersise greatest

A

Growth

162
Q

What is the dominant influence on bone strength

A

Loading

163
Q

What property of the load results in the highest strain rate on the bones

A

Magnitude of the load

Phase 1 (30 decks)

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