week 1 Flashcards
- general overview of the limbs - pectoral and pelvic girdles - brachial and lumbosacral plexuses - skeletal and cardiac muscle - sarcomere structure - glenohumeral and hip joints - osteology of the upper limb - excitation-contraction coupling in skeletal and cardiac muscle - smooth muscle contraction - GALS - screening - intro to metabolism - biological sample analysis - the use of medicines - malignant hyperthermia - pectoral region and axilla (133 cards)
1
Q
Which structure passes through the suprascapular notch?
A
suprascapular nerve
2
Q
what makes each of the walls of the axilla?
A
anterior wall: pec. major, clavipectoral fascia, subclavius
medial wall: ribs 1-4 and associated intercostal spaces, serratus anterior
lateral wall: bicipital groove of humerus
posterior wall: subscapularis, teres major, latissimus dorsi
3
Q
Where are the trunks of the brachial plexus formed?
A
posterior cervical triangle
4
Q
Cords of the brachial plexuses are named according to their positions relative to ….?
A
the axillary artery
5
Q
what are the 2 largest nerves from the lumbosacral plexus?
A
sciatic nerve and femoral nerve
6
Q
How is the terminal cutaneous branch of the femoral nerve called?
A
saphenous nerve
7
Q
Which of the two terminal branches of the sciatic nerve is the smallest?
A
Common peroneal (fibular) nerve
8
Q
Define auto-rhythmicity.
A
the ability of a cell to stimulate its own action potentials
9
Q
Give 4 characteristics of a skeletal muscle fiber.
A
- multinucleated
- many mitochondria
- t-tubules
- myofibrils and sarcomeres
10
Q
Which type of intercellular link acts as a mechanical connection in the intercalated disc between adjacent cardiac muscle cells?
A
Desmosomes
11
Q
What is the central pore diameter of a gap junction?
A
1.5nm
12
Q
Which area of the brain activates skeletal muscle?
A
Primary motor cortex
13
Q
What is a motor unit?
A
motor neuron and the skeletal muscle fibers it innervates
14
Q
How many motor neurons innervate one specific motor fiber?
A
one
15
Q
Describe how motor neurons are well adapted to their function.
A
large diameter -> low resistance
+ myelinated
–> high velocity -> minimal delay
16
Q
The neurotransmitter of the neuromuscular junction?
A
acetylcholine
17
Q
Define motor end-plate
A
the region of the muscle fiber that lies directly under the terminal portion of the axon
18
Q
Define neuromuscular junction.
A
the junction of an axon terminal with the motor end plate
19
Q
Which enzyme degrades acetylcholine and what are the products?
A
acetylcholinesterase (AChE) degrades ACh into acetyl and choline
20
Q
How many ACh have to bind to one nicotinic cholinergic receptor for it to open?
A
Two
21
Q
In myasthenia gravis, what do antibodies target?
A
nicotinic ACh receptors of skeletal muscle only
22
Q
What is perimysium?
A
the connective tissue surrounding the different fascicles of a skeletal muscle
23
Q
Define sarcomere.
A
the functional unit of the myofibril, that lies between two successive Z lines
24
Q
What 3 proteins make up a thin filament in skeletal muscle?
A
actin, troponin and tropomyosin
25
Give 4 structural proteins of the sarcomere.
titin, nebulin, alpha-actinin, myomesin
26
What gives skeletal and cardiac muscles their striated appearance?
the orderly arrangement of thick in thin filaments in the myofibrils
27
What protein lets calcium from t-tubules into the skeletal muscle cell as a result of an action potential?
dihydropyridine (DHP) receptor
28
Give the difference between the dyad of cardiac muscle and the triad of skeletal muscle.
Dyad: 1 terminal cisternae associated to 1 t-tubule
Triad: 2 terminal cisternae associated to 2 t-tubules
29
Explain in 2 different ways what excitation-contraction coupling is.
linkage between excitation of the muscle fiber membrane and the onset of contraction
conversion of an electrical stimulus to a mechanical process
30
Explain latent period in skeletal muscle and give one rejected hypothesis.
delayed onset of contraction after the arrival of the action potential, caused by the fact that changes in the electric field are restricted to the immediate vicinity of the plasma membrane
Rejected hypothesis: diffusion of a signalling substance from the extracellular space - would take longer than a 10ms delay
31
Give two key differences between the excitation-contraction coupling of skeletal muscle and that of cardiac muscle.
SKELETAL MUSCLE
- no extracellular calcium needed for contraction to happen
- latent period
CARDIAC MUSCLE
- 25% of calcium needed for contraction from extracellular fluid
- plateau during repolarisation
32
What are the intracellular calcium concentrations of skeletal muscle at rest and when contracted?
at rest: <10^-7M
| contracted: >10^-5M
33
What is the key event that ultimately leads to force generation in skeletal muscle?
increase in intracellular calcium
34
Which fatal condition would you prescribe Dantrolene fore?
malignant hyperthermia
35
Describe the role of calsequestrin.
enzyme found in the sarcoplasmic reticulum that binds 43 calcium ions at once in order to reduce the gradient calcium reuptake has to face
36
The neurotransmitter acetylcholine is involved in the autonomic innervation of cardiac muscle. What is it action?
slows heart rate by acting solely on pacemakers
37
Which characteristic that all cardiac cells possess is responsible for arrhythmia?
auto-rhythmycity
38
Na:Ca ratio for sodium-calcium exchange pump during relaxation of cardiac muscle
3Na:1Ca
39
Which mechanism prevents the influx of sodium ions from starting a depolarisation of the sarcolemma as the cell relaxes?
sodium-potassium pump
| --> pumps sodium back out of cell
40
What are the 7 things to do when confronted by malignant hyperthermia?
- Dantrolene
- cessation of anaesthesia
- cooling the body
- sodium bicarbonate
- IV hydration
- diuretics
- mechanical hyperventilation
41
What is the only joint linking the axial skeleton to the pectoral girdle?
sternoclavicular joint
42
How do you recognize the lateral side of the clavicle compared to the medial side?
MEDIAL SIDE
cylindrical 2/3rd
LATERAL SIDE
flattened 1/3rd
conoid tubercle fo conoid part of coracoclavicular ligament
43
Which structure(s) go through the suprascapular notch?
suprascapular nerve
44
Name the 2 tubercles associated with the glenoid fossa.
infraglenoid and supraglenoid tubercles
45
Which 3 muscles attach to the coracoid process of the scapula?
short head of biceps, coracobrachialis, pectoralis minor
46
Which 4 muscles attach to the intertubercular sulcus of the humerus?
long tendon of biceps, teres major (medial lip), pectoralis major (lateral lip), latissimus dorsi
47
Where on the humerus would you find the deltoid tuberosity?
midway down, anterolaterally
48
Which 3 muscles attach to the greater tubercle?
supraspinatus, infraspinatus, teres minor
49
Which bones respectively articulate with the capitulum and trochlea of the humerus?
Capitulum: radius
Trochlea: ulnar
50
Where is the styloid process of the radius? What bones does it articulate with?
Most distal part of the radius
| Scaphoid and lunate bones
51
How many surfaces are there on the radius?
3: anterior, lateral, posterior
52
Where is the head of the ulna?
at the distal end of the bone
53
Which bones of the hand articulate with the ulna?
None
54
Name the carpal bones.
lateral to medial
PROXIMAL ROW: scaphoid, lunate, triquetrum, pisiform
DISTAL ROW: trapezium, trapezoid, capitate, hamate
55
Name the anterior protrusion of the hamate bone.
Hook of hamate
56
How many phalanges are there per finger?
3
57
What type of muscle surrounds hollow structures that need to accommodate changes in volume?
Smooth muscle
58
In smooth muscle, can width become longer than length during contraction?
NO, length always > width
59
Give the actin:myosin ratio in smooth muscle
actin: myosin 15:1
60
Which filaments attach to the dense bodies in smooth muscle?
Actin, thin filament
61
Which regulatory protein is find on actin in skeletal and cardiac muscle, but not in smooth muscle?
Troponin
62
Which 2 structures provide structure to smooth muscle cell?
Membrane dense areas (attachment plaques) and intermediate filaments
63
Which enzyme phosphorylates myosin to allow contraction in smooth muscle?
Myosin light chain kinase (MLCK)
64
Give 5 inputs that influence smooth muscle contractile activity.
- autorhythmicity
- neurotransmitters
- hormones
- locally induced changes in the chemical composition (paracrine factors, acidity, oxygen, osmolarity, ion concentration...)
- stretch
65
Distinguish between pacemaker potential and slow waves.
Pacemaker potential = membrane potential change occurring during the spontaneous depolarisation to treshold
slow waves = regular variations in ion flux across the membrane that makes the membrane potention drift up and down
66
Distinguish between the two types of receptors noradrenaline binds to in vascular smooth muscle and in broncholiar smooth muscle.
VASCULAR SMOOTH MUSCLE
alpha-adrenergic receptor
enhances contraction of blood vessel
BRONCHIOLAR SMOOTH MUSCLE
beta 2-adrenergic receptor
relaxation of airway
67
What type of local factor is nitric oxide (NO) for smooth muscle?
paracrine factor
68
What kind of ion channel is activated by stretch in smooth muscle?
Mechanosensitive ion channels
69
Which type of smooth muscle is definitely not spontaneously active? Give an example.
multiunitary smooth muscle like piloerectors, vas deferens or iris
70
Which 3 questions do you ask the patient in GALS?
"Do you have any pain or stiffness in your muscles, joints or back?"
"Can you dress yourself completely without any difficulty?"
"Can you walk up and down the stairs without any difficulty?"
71
Give 5 things you are looking for when you inspect the patient from the back in a GALS screening.
- normal shoulder bulk
- abnormal spine alignment
- level iliac crests
- gluteal muscle bulk and symmetry
- popliteal swellings
- calf muscle bulk
- hind foot abnormalities
72
What movement would you ask from the patient in order to assess wrist extension in a GALS screening?
prayer sign
73
Does the internal rotation of the hip bring the toes laterally or medially?
Laterally
74
What would callus under the foot indicate?
abnormal weight distribution while walking
75
Explain the difference between a spectrophotometer and a colorimeter.
A spectrophotometer uses a prism to separate light.
| A colorimeter uses filters.
76
What are the 4 components of a spectrophotometer?
- a light source
- a prism
- a sample holder
- a photocell
77
In spectrophotometry, what is a blank sample?
a sample containing no solute or dye, that is used to calibrate the machine
78
In spectrophotometry, what kind of relationship is expected to be deduced from a plot of the absorbance against concentration?
a linear relationship
79
Name the 4 origins of the pectoralis major
- medial third of clavicle
- sternum
- ribs 1-6
- costal cartilages
80
Which structure(s) is/are supplied by the lateral pectoral nerve?
Pectoralis major
81
Which vein would you find in the deltopectoral groove?
cephalic vein
82
Where does the deltoid insert?
deltoid tuberosity
83
What movement of the arm does the contraction of the posterior fibers of the deltoid cause?
extension
| lateral rotation
84
What movement of the arm does the contraction of all the fibers of pectoralis major cause?
Medial rotation
85
Where does the short head and the long head of the biceps respectively attach to on the scapula?
short head: coracoid process
| long head: supraglenoid tubercle
86
Which nerve innervates serratus anterior?
long thoracic nerve (C5-C7)
87
What is the purpose of screening?
- to save lives or improve quality of life through early risk identification
- to reduce the risk of developing a serious condition or its complication
88
Give 3 out of 9 2008 WHO criteria for screening.
- response to a recognised need
- objectives defined and evaluation planned at outset
- defined target population
- scientific evidence of effectiveness
- comprehensive and integrated programme
- quality assured, with systemic mitigation of risks
- informed choice, confidentiality and respect for autonomy
- programme should promote equity and access to screening
- overall benefits should outweight the harm
89
How do you calculate the sensitivity of a screening test?
100 x number of results where disease detected in people with the disease/number of people with the disease
90
How do you calculate the negative predictive value of a screening test?
100 x number of people who do not have a disease and have a negative test result / number of people with a negative test result
91
Is it incidence or prevalence that strongly affects positive and negative predictive values of a screening test?
Prevalence
92
Give 3 harms and 3 benefits of screening tests.
HARMS
- false reassurance
- over-investigation and treatment
- anxiety
- longer period of morbidity with unaltered prognosis
- harm from screening test
- opportunity cost
- increased health inequalities
BENEFITS
- reduced incidence
- reduced mortality
- earlier, less radical treatment
- cost-effective
- overall population benefit
93
What is the gold standard for measuring effectiveness of screening?
Randomized controlled trial
94
Give 3 categories of people that represent a challenge for screening coverage.
- ethnic minorities
- immigrants
- travelers
- prisoners
- students
95
How do you calculate the uptake of a screening test?
100 x screened population/invited population
96
Define metabolism
means by which organisms extract energy from their environment and use this to synthesize large molecules
97
Differentiate between anabolism and catabolism.
ANABOLISM
energy-requiring process by which large molecules are built from smaller ones
CATABOLISM
energy-producing breakdown of large molecules to smaller ones
98
Give the resting human consumption of oxygen in mL/min
250mL/min
99
Give the equation for the free energy change (DG) of the reaction V + W X + Y
DG = DG0 + RT ln ([X][Y]/[V][W]
100
What type of reaction is the following:
| ADP --> AMP + energy
hydrolysis
101
Give the amount of energy released when ATP is hydrolysed to ADP.
-7 to -12 kcal/mol
102
What kind of substrates can directly undergo glycolysis in order to make ATP?
- fatty acids and glycerol
- glucose and other sugars
- amino acids
103
Name 3 hormones that can have a major regulatory effect on some enzymes.
- insulin
- glucagon
- adrenaline
104
Give 3 aims of medicine regulation.
- to ensure medicines have required quality, safety and efficacy
- to ensure medicines are appropriately manufactured, stored, distributed and dispensed
- allows detection of illegal manufacturing and trade
- provides health professionals and patients with information to enable safe use of medicines
- ensures promotion and adverting is fair
- provides framework to allow access to new medicines
105
What does MHRA stand for?
Medicines and Healthcare products Regulatory Agency
106
How long does a marketing authorization for a product issued by the MHRA last for?
5 years
107
Distinguish between unlicensed and off-label prescriptions.
UNLICENSED
the medicine has no marketing authorization
examples: imported medications, medications made specially for a patient
OFF-LABEL
the medicine has a marketing authorization but is prescribed outwith the terms of license
examples: different dose, age of patient...
108
```
Give one drug of each of the following categories:
class A, class B, class C
```
```
class A - cocaine, heroin, methadone, magic mushrooms, MDMA
class B - cannabis, mephedrone
class C - anabolic steroids, benzodiazepines
```
109
Give one example of controlled drug.
Lysergide, opiates, some benzodiazepines, anabolic steroids, codeine...
110
Differentiate between GSL, P and POM medicines.
GSL - General Sales List
a medicine that can be sold in registered pharmacies but also in other retail outlets that can close as to exclude the public
P - Pharmacy only
a medicine sold from registered pharmacy premises by a pharmacist or a person acting under the supervision of a pharmacist
POM - Prescription Only Medicine
medicine with a prescription written by an appropriate practitioner before it can be sold or supplied
111
Give 4 examples of appropriate practitioners.
- doctor
- dentist
- supplementary prescriber
- nurse independent prescriber
- pharmacist independent prescriber
- EEA and Swiss doctors (limited)
- community practitioner nurses (limited)
- optometrist independent prescribers (limited)
112
How long is a prescription for a controlled drug valid for?
28 days
113
What does a black triangle on the box of a medication mean?
It is a newly licensed medicine that requires intensive monitoring.
114
Name the SITS (rotator cuff) muscles.
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
115
TRUE OR FALSE
The glenohumeral joint is more likely to dislocate superiorly.
FALSE
116
What tendon is protected by the subacromial bursa?
supraspinatus tendon
117
Which structures form the coraco-acromial arch?
coracoid process
acromion
coraco-acromial ligament
118
There are two parts in the acetabulum. Which of the two articulates with the head of the femur?
lunate surface
119
Which structure does the artery protected by the foveal ligament supply?
epiphysial plate of the head of the femur
120
Which ligament is the strongest of the human body?
the iliofemoral ligament
121
The vascular supply of the hip joint involves two anastomoses. What are their names and which arteries do they respectively include?
CRUCIATE ANASTOMOSIS
- retinacular branches of the medial and lateral circumflex femoral arteries
- obturator artery
TROCHANTERIC ANASTOMOSIS
- medial and lateral circumflex femoral arteries
- superior and inferior gluteal arteries
122
Name the 5 flexors of the glenohumeral joint.
- pectoralis major
- deltoid
- biceps
- coracobrachialis
- latissimus dorsi (for the already extended arm)
123
Name the 4 extensors of the glenohumeral joint.
- deltoid
- latissimus dorsi
- triceps
- teres major (for the already flexed arm)
124
What are the prime movers of the abductors muscles of the glenohumeral joint used to reach an angle of 35 degrees?
before 15 degrees: supraspinatus
| from 15 to 35: deltoid
125
Name the 2 muscles that are not prime movers for lateral rotation of the glenohumeral joint.
Deltoid
| Teres minor
126
Which of the 4 rotator cuff muscles do not rotate the arm?
Supraspinatus
127
Which nerve pierces coracobrachialis?
Musculocutaneous nerve
128
What are the boundaries of the quadrangular space for gateway to the scapular region?
humerus, long head of triceps, teres minor, teres major
129
Give the name and innervation of the muscles making up the ilipsoas.
Iliacus - femoral nerve
| Psoas major - anterior rami of L1-L3
130
Name the 3 muscles that compose the hamstring. What function do they perform?
- Biceps femoris
- semitendinous
- semimembranosus
extension of the hip
131
What are the 3 abductors of the hip? What other function do they all also perform?
- tensor fascia latae
- gluteus medius
- gluteus minimus
medial rotation of the hip
132
Which structure is not enclosed within the femoral sheath in the femoral triangle?
the femoral nerve
133
How do you call the opening of the femoral canal?
teh femoral ring
