MSK Flashcards

1
Q

Approx. how many bones do you have when you are born compared to when you are an adult & why

A

300 when you are born but only 206 bones when you are an adult
Because bones combine to form bigger bones in the adult body

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2
Q

What is the inorganic/mineral bone matrix made of and what strength does it have

A

hydroxyapatite crystals

Compression strength

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3
Q

What is the organic bone matrix made of and what strength does it have

A

Collagen and proteoglycans

Flexible strength

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4
Q

What are osteochondral progenitor cells

A

undifferentiated stem cells

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5
Q

What are osteoblasts/what do they do

A

Lay down bone
Come from the bone marrow
only have one nucleus
Work in teams to build bone

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6
Q

What are osteocytes/what do they do

A

Mature bone cells formed in lacunae

Formed when osteoblast becomes embedded in material it has created

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7
Q

What is a lacunae

A

cavity or depression in the bone

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8
Q

What are osteoclasts/what do they do

A

Resorb (remove) bone

Absorbs bone during growth and healing

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9
Q

What do bone-lining cells do

A

regulate movement of ca2+ and PO4-

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10
Q

Describe cortical bone and what’s another name for it

A

Compact bone
Thicker than cancellous bone
And very dense

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11
Q

Describe what trabecular bone is and another name for it

A

Cancellous bone

Much lighter and less dense than cortical

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12
Q

What are the two types of ossification

A

Endochondral and intramembranous

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13
Q

Describe endochondral ossification

A

From cartilage template
ossified slowly and then turned into bone
Completed from teens to early twenties

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14
Q

Describe intramembranous ossification

A

Direct deposition of bone on thin layer of connective tissue (involved in formation of skull)

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15
Q

Describe appositional bone growth

A

Increases the bones width
osteoblast in periosteum secrete matrix and become trapped as osteocytes
osteoclasts increase diameter of medullary cavity
Continues increasing diameter until skeletal maturity

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16
Q

Describe endochondral bone growth

A

Increases the bones length
Requires interstitial growth from the cartilage first
Occurs at epiphyseal growth plate
Stops when the growth plates ossify

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17
Q

What is Wolffs law

A

States that you bones will adapt depending on the stress you put on them

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18
Q

What does more stress mean for bones? Less stress?

A

More stress means increased osteoblast activity which means more bone
Less stress means decreased osteoblast activity which means less bone

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19
Q

What are the five factors influencing bone growth and remodelling

A
mechanical factors
genes
hormones
ageing
disease
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20
Q

Describe how genes have an influence on bone growth/remodelling

A

determine their potential shape and size

Directly influences: growth hormone released, hormone receptors on bone, ability to absorb nutrients from the gut

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21
Q

What are the genetic disorders associated with bones

A
Dwarfism (achondroplasia dwarfism is same size head and trunk but shorter limbs)
Turners syndrome (only affects females as it affects the X chromosome, causes short height, heart defects and failure of ovaries to develop)
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22
Q

How do hormones influence bone growth and remodelling

A

Growth, sex, thyroid hormones influence cell differentiation and metabolism

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23
Q

How does ageing influence bone growth and remodelling

A

Osteoblast matrix production slows in comparison to osteoclast matrix resorption
Decreased collagen deposition results in more brittle bones

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24
Q

What disease is most associated with bones

A

Osteoporosis
Cancellous bone mostly affected if connections lost
causes brittle bones

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25
Q

What are the three types of cartilage

A

hyaline
fibrocartilage
elastic

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26
Q

Where is hyaline cartilage found

A

at the end of long bones

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27
Q

What are the two ways cartilage grows

A

Appositional growth and interstitial growth

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28
Q

Explain appositional growth in cartilage

A

Chondroblasts

increase in diameter of bones by addition of bone tissue at the surface of bones

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29
Q

Explain interstitial growth in cartilage

A

chondrocytes

lengthening of the bone resulting from growth of cartilage and its replacement with bone tissue

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30
Q

What is the perichondrium

A

type of connective tissue that functions in the growth and repair of cartilage

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31
Q

Describe the outer and inner layer of the perichondrium

A

outer layer has dense irregular connective tissue with fibroblasts
Inner layer has fewer fibres with chondroblasts

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32
Q

What type of cartilage is articular cartilage

A

hyaline cartilage

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33
Q

Does articular cartilage have perichondrium

A

no

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34
Q

Describe growth in articular cartilage

A

Similar to growth plate

columns of cells turn into calcified cartilage which turns into bone

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35
Q

What is the function of articular cartilage

A

smooth (reduces friction, low-wear surface, reduces heat which reduces protein damage)
deformable and elastic (distributes load easily, increases surface area which decreases force)

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36
Q

Describe adult articular cartilage

A

aneural and avascular

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37
Q

What are three things that affect bone density

A

availability of substrates
biochemical factors
physiological factors

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38
Q

Give some examples of how availability of substrates affect bone density

A
Calcium intake
calcium absorption (Vit D intake)
Functionality of PTH (magnesium deficiency)
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39
Q

Give some examples of how biochemical factors affect bone density

A

hormones

steroid hormones, oestrogen, thyroid hormones

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40
Q

Give some examples of how physiological factors affect bone density

A

Weight bearing exercise
smoking (affects bone turnover)
BMI
healthy diet (oily fish, whole grains)

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41
Q

6 factors affecting fracture risk

A
age
smoking status
medication (steroids)
Bone density
alcohol intake
previous fracture
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42
Q

4 functions of skeletal muscle

A

movement
control posture
remove (from blood) and store glucose
generate heat (temperature regulation)

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43
Q

what does iso mean? metric? tonic?

A

iso=same
metric=measure
tonic=tensions

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44
Q

Name 3 skeletal muscle relaxants

A

botulinum toxin
curare
succinylcholine

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45
Q

How is botulinum toxin a skeletal muscle relaxant

A

prevents release of Ach-containing vesicles
causes paralysis of muscles and inhibition of secretion from exocrine glands normally stimulated by parasympathetic nervous system

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46
Q

How is curare a skeletal muscle relaxant

A
blocks nAchRs (nicotinic acetylcholine receptors) to cause paralysis
(used during surgery to prevent muscle spasms)
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47
Q

How is succinylcholine a skeletal muscle relaxant

A

(also known as suxemethonium)

short acting block of nAchRs (used during intubation)

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48
Q

What is the function of the sarcoplasmic reticulum

A

store calcium
release calcium rapidly (stimulated by AP)
rapidly restore calcium (using ATP driven calcium pumps)

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49
Q

What is the function of t tubules

A

to quickly convey the action potential deep inside the fibre

continuous with sarcolemma (surface membrane)

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50
Q

What are two membrane receptors in triads

A

dihydropyridine (DHP)

ryanodine receptors

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51
Q

what is a triad

A

where t tubule is surrounded by SR on both sides

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52
Q

Describe dihydropyridine (DHP) receptors

A

receptors function as voltage sensors (on t-tubule membranes)

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53
Q

Describe ryanodine receptors

A

function as calcium release channels on the sarcoplasm reticulum membrane

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54
Q

what do the membrane receptors in triads require for mechanism

A

voltage sensor in t-tubule membrane to detect AP

and a calcium release channel that is opened by the voltage sensor

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55
Q

What is malignant hypothermia

A

rare inherited condition
caused by mutation in ryanodine receptors
triggered by volatile anaesthetics

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56
Q

What does the axial skeleton include

A

skull/spine

encasing CNS

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57
Q

What does the appendicular skeleton include

A

the limbs

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58
Q

What are the four categories of bones

A

short
long
flat
irregular

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59
Q

What types of bones are formed from endochondral ossification

A

short
long
irregular

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60
Q

what types of bones are formed by intramembranous ossification

A

flat

irregular

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61
Q

Give an example of a short bone, long bone, flat bone and irregular bone

A

short=carpal bones in hand
long=humerus/femur
flat=bones in the skull
irregular=vertebrae

62
Q

what is the epiphysis?

A

the end of the long bone

ossifies separately from the shaft/diaphysis but becomes fixed to it when full growth is attained

63
Q

What is the diaphysis

A

the shaft of a long bone

64
Q

What is the metaphysis

A

Wide portion near the end of long bones

where growth occurs

65
Q

What is epiphysis covered in

A

articular cartilage

66
Q

What are Haversian systems

A

Haversian canals surrounded by blood vessels and nerve fibres throughout the bone and communicate with osteocytes

67
Q

What is 80% of skeleton weight

A

cortical bone

68
Q

What are osteoprogenitor cells derived from

A

mesenchymal stem cells

69
Q

What are osteoblast cells derived from

A

mesenchymal stem cells via osteoprogenitor cells

70
Q

What do osteoblasts make

A

new bone matrix (type I collagen, ALP-initiates calcification, calcium phosphate)

71
Q

What are osteocytes derived from

A

osteoblasts

72
Q

What are osteoclasts derived from

A

monocytes

73
Q

What are osteoclasts important in

A

breaking down and remodelling bone

74
Q

How do osteoclasts bind to bone surfaces

A

by binding to little proteins called osteopontin

75
Q

When a force is applied to bone which side is compressing and which side is under tension

A

the side that force is being applied to is compressing and the opposite side is under tension

76
Q

What are the two types of bone healing

A

primary and secondary

77
Q

Describe primary bone healing

A

needs absolute stability and compression
does not form a callous
(can get this stability using plates and screws, usually used for joints because don’t want a callous in a joint0
Needs less than 2% strain

78
Q

What is a callous

A

bony healing tissue which forms around the end of broken bones

79
Q

Describe secondary bone healing

A

Needs relative stability
Callous formation
(achieved by putting splint/cast on)
can have between 2-10% strain

80
Q

Four stages of secondary bone healing

A
haematoma (inflammatory/reactive phase)
soft callous (reparative phase)
hard callous (reparative phase)
remodelling (remodelling phase)
81
Q

Describe what happens during the haematoma (inflammatory/reactive) phase of secondary bone healing

A
Bruising and haematoma formation
solid swelling of clotted blood
haematoma forms template for callous
signals for cells to initiate healing 
(mesenchymal stem cells, osteoprogenitor cells, platelets, macrophages, neutrophils)
82
Q

Describe what happens during the soft callous (reparative) phase of secondary bone healing

A

fibroblast cells come into area (make fibrous tissue, produce type II collagen)
new blood vessels grow through haematoma (have connective tissue and provide some stability)
fibroblasts mature into chondroblasts (make & lay down cartilage framework)

83
Q

Describe what happens during the hard callous (reparative) phase of secondary bone healing

A
osteoblasts come in
they lay down type I collagen
mineralise bone (gets stiffer and harder)
84
Q

Describe what happens during the remodelling phase of secondary bone healing

A

as bone heals people use bone more
bone will then adapt
osteoblasts come in cutting cone formation
(tipped with osteoclasts that cut through regular woven bone)

85
Q

What is it called when bones do not heal

A

non-union

86
Q

What is hypertrophic non-union

A

consequence of too much movement (exceeded 10% strain)

87
Q

What is atrophic non-union

A

avascular and inert (wouldn’t heal even under correct conditions)
usually needs a bone graft
(consequence of poor bone stability and poor blood supply)

88
Q

What is sarcopenia

A

used to describe inevitable loss of muscle mass and strength even in the healthy elderly
force and speed of contraction is reduced

89
Q

What are some of the consequences of sarcopenia

A
loss of muscle mass
loss of muscle strength 
increase risk falls
loss of autonomy
(reduced loading of skeleton from sarcopenia can result in osteopenia)
90
Q

What three things is osteopenia characterised by

A

bone loss
reduced bone mineral density
micro-architecture deterioration

91
Q

What does osteopenia mainly affect

A

wrist
hip
vertebrae

92
Q

What happens to cortical bone with ageing

A

strength decreases by 2% per decade from 20 yrs

toughness decreases by 7% per decade

93
Q

What happens with ageing of fibrous tissue

A

cell content changes
collagen cross-links increase and mature
non-enzymatic glycation makes tissue yellow and stiffer
micro damage accumulates and makes tissue weaker
cell less responsive to mechanical stimuli

94
Q

What happens with ageing on cartilage

A
decreased proteoglycans
decreased aggregation of proteoglycans
increased collagen and cross-links
increased non-enzymatic glycation
increased apoptosis
increased stiffness
95
Q

What does hyaline cartilage do

A

its a shock absorber and load bearer

96
Q

What are the features of hyaline cartilage

A

turgor (high water content), resilient, avascular and aneural

97
Q

What is in the matrix of hyaline cartilage

A

glycosaminoglycans, hyalinuronic acid, chondroitin sulphate, keratan sulphate

98
Q

What type of cells make up hyaline cartilage and what fibres are present

A

cells=chondrocytes

fibres=collagen type II

99
Q

What are the four types of skeletal cells

A

osteoblasts
osteocytes
osteoclasts
megakaryocytes

100
Q

Describe osteoblasts

A

make bone
synthesise osteoid and mediate mineralisation
found lined up along bone surfaces

101
Q

Describe osteocytes

A

largely inactive osteoblasts trapped within formed bone
form well connected network via caniculi (thin protrusions)
play important role in mechanosensation

102
Q

Describe osteoclasts

A

phagocytic cells that erode bone
important with osteoblasts in turn/over remodelling of cells
very large/multinucleate cells derived from macrophage/monocyte cell lines
found on/near bone surfaces

103
Q

Describe megakaryocytes

A

lobulated nucleus
responsible for production of platelets
found in bone marrow

104
Q

What are the four properties of muscle

A

elasticity
excitability (ability to respond to stimuli)
contractability
extensibility (ability to stretch without tearing)

105
Q

What is epimysium (muscle connective tissue)

A

outside of a muscle

dense collagenous sheath

106
Q

What is perimysium (muscle connective tissue)

A

sheath surrounding a bundle of muscle fibres

107
Q

What is endomysium (muscle connective tissue)

A

thin connective tissue layer surrounding each myofibre

108
Q

What and where is an epiphyseal growth plate

A

hyaline cartilage plate in the metaphysic at the end of each long bone

109
Q

What is the periosteum

A

dense layer of vascular connective tissue enveloping bones(except at surfaces of joints)

110
Q

What is the endosteum

A

thin vascular connective tissue that lines inner surface of bony tissue that forms the medullary cavity of long bones

111
Q

What is the meniscus

A

piece of cartilage that provides cushion between the femur and the tibia
(two menisci in each knee joint)

112
Q

What does the patella tendon attach to

A

to the bottom of the knee cap to the top of the shin bone (tibia)
attached to the quadriceps muscle by the quadriceps tendon

113
Q

What is a synovial (joint) space

A

site at which articulating surfaces of bones contact eachother

114
Q

What does a synovial membrane do

A

lines joint cavity and made up of two layers

115
Q

what is intimal synovial membrane

A

responsible for content of synovial fluid
(1-4 cell layers thick)
(does not have a basement layer membrane)

116
Q

What is subintimal synovial membrane

A

made up of fibrous, areolar and fatty tissues

117
Q

What is adipose tissue

A

specialised connective tissue consisting of lipid rich cells (adipocytes)
store energy in the form of fat

118
Q

What is acute pain

A

short duration
result of injury or disease
important protective role

119
Q

What are MSK examples of acute pain

A

fracture
muscle sprain
acute post-operative pain

120
Q

What is chronic pain

A

pain that lasts longer than 3-6months
can be related/unrelated to tissue damage
no useful biological function

121
Q

What are MSK examples of chronic pain

A

chronic back pain
osteoarthritis
chronic post-operative pain

122
Q

What is assessed in a pain assessment

A

sensory aspect of pain
physical function
emotional wellbeing/psychological aspect
role and interpersonal functioning

123
Q

What is meant by sensory aspect of pain

A

intensity, location, frequency, quality

124
Q

what is meant by physical function (in a pain assessment)

A

activity levels, daily life, exercise

125
Q

What is meant by emotional wellbeing/psychological aspect (in a pain assessment)

A

pain related distress
depression
coping

126
Q

what is meant by role and interpersonal functioning (in a pain assessment)

A

work
relationships
social activities

127
Q

What are three ways to assess acute pain

A

verbal descriptor scales
numeric rating scales
visual analogue scales

128
Q

describe a verbal descriptor scale

A

asking patients if there is no pain, mild pain, moderate pain or severe pain

129
Q

Describe a numeric rating scale

A

0-10 with 10 being most severe pain

130
Q

describe a visual analogue scale

A

ask patient to place a marker of a scale of no pain to high intensity pain

131
Q

How do you assess chronic pain

A

brief pain inventory

132
Q

What are the challenges of using a questionnaire to assess pain

A

pain fluctuates over time
impact of co-morbidities & pain elsewhere
adaption and avoidant strategies

133
Q

what is the hierarchy of pain assessment techniques

A
self-report
identify potential causes of pain
observe patient behaviours
surrogate reporting of pain
attempt an analgesic trial
134
Q

what is the mineral phase of bone made of

A

hydroxyapatite (type of calcium phosphate)

135
Q

what is the organic phase of bone made of

A

collagen and other protein

136
Q

How much calcium is moved out of the bones and into the ECF

A

500mmol every 24 hours

137
Q

What is PTH

A

parathyroid hormone (produced by parathyroid gland)

138
Q

What does PTH do in the kidney

A

Increases reabsorption of calcium in distal tubules
increases phosphate excretion
increases formation of active vit D

139
Q

What does PTH do in the bone

A

stimulate bone resorption

breaking down into calcium and phosphate to be absorbed by the body

140
Q

What is a low calcium level called

A

hypocalcaemia

141
Q

What is the calcium receptor

A

CaSR

142
Q

What happens if the body detects low levels of calcium

A

body would produce high levels of PTH to get more calcium in the body

143
Q

Describe vit D3

A

not biologically active
formed from UV light on skin
found in oily fish
highly fat soluble (stored in adipose tissue)

144
Q

Where is vit D2 found

A

in supplements

145
Q

What happens with vit D in the liver

A
it is where it is first hydrolysed
forms 25(OHD) =25 hydroxycholecalciferol
146
Q

What bone in the wrist forms from 1-3 months

A

capitate

147
Q

what bone in the wrist forms from 2-4 months

A

hamate

148
Q

what bones in the wrist form from 2-4 years

A

triquetral

lunate

149
Q

what bones in the wrist form from 4-6 years

A

scaphoid
trapezium
trapezoid

150
Q

what bone in the wrist forms from 8-12 years

A

pisiform (little bone stuck on the edge of triquetral)

151
Q

what are the four types of children fractures

A

green stick
torus (buckle)
complete
salter harris

152
Q

What is rickets called in adults

A

osteomalacia