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QMU Module 5 Questions & Answers

QMU Module 5 Questions & Answers

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QUESTIONS MAKER UNIT (QMU

)

Module 5: Musculoskeletal System
Questions & Answers

2010/2011

‫ج ا م ع ة ا إل س ك ن د ري ة‬

Module 5: Musculoskeletal System

2010/2011

CARTILAGE & BONE 1. All the following are functions of cartilage EXCEPT a. firm and flexible ECM allows cartilage to bear mechanical stress without permanent distortion b. its smooth-surfaced provides sliding surface for articulation inside joint cavities c. cartilage form epiphyseal plates that play an important role in the growth of flat bone d. cartilage acts as a shock absorber due to its resilient characteristic 2. What is the importance of microcavities and irregularities in the articulating surface of any synovial joints? a. to content the synovial fluid which serves as synovial fluid reservoir b. squeezed out mechanically during walking to maintain thick layer of synovial fluid on cartilage surface c. to increase contact area of the articulating surfaces as to decrease joint stresses d. to absorb nutrients and gases from synovial fluid 3. All the following are effect of absence of collagen EXCEPT a. loss of cell-cell communication b. cell migration as in metastasis c. loss of cell shape d. limitation to cell locomotion 4. All the following are functions of bone EXCEPT a. bone has an important metabolic function by acting as minerals reservoir b. protection of the external vital organs c. gives attachment to different body muscles helping in locomotion d. support and maintenance of body stature 5. All of the following events occur in zone of ossification in endochondral ossification EXCEPT a. vascular mesenchymal bud arise from cellular layer of periosteum to invade ossifying zone b. macrophages differentiated into active osteoclast which phagocytose the calcified cartilage matrix and remnants of dead chondrocytes leaving wide empty lacunae c. osteoblast come to lie side by side lining the formed cavities and start to lay down bony matrix and promote its calcification d. release of alkaline phosphatase causing calcification of cartilage matrix

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Module 5: Musculoskeletal System
PERIPHERAL NERVES 6. The correct statement about neuron is a. Pseudo-unipolar neuron presents in vestibular ganglia b. Polygonal neuron presents in spiral ganglia c. Granule cell presents mainly in cerebral cortex d. Pyriform neuron presents in the retina

2010/2011

7. All the following are correct statements concerning potassium ion EXCEPT a. Hydrated form of K+ ions are smaller than hydrated form of Na+ b. The permeability of K+ ions is 50-100 times greater than its permeability to Na+ c. Potassium ion is one of the chief ions on the inner surface d. The negative interior of is due to lower diffusion of K+ out of the cell than Na+ diffusion into the cell in resting state 8. The excitable tissues are a. Nervous tissue b. Muscular tissue c. Connective tissue d. A and B e. B and C 9. The membrane is absolutely impermeable to a. Clb. Proteins c. HCO3 d. HPO4 10. All of the following have ectodermal origin EXCEPT a. Astrocytes b. Microglia c. Oligodendroglia d. Ependymal cells 11. Nerve block includes; a. Failure if conduction of nerve impulse b. Loss of excitability c. No generation or propagation of nerve impulses d. All of the above MUSCULAR TISSUES 12. Regarding the muscular tissue, the following are true EXCEPT: a. Muscle fibers are ectodermal in origin except muscles of the iris and myoepithelial cells around the acini which are mesodermal in origin b. Theskeletal muscle includes the diaphragm. c. Lymphatic vessels are present in both epimysium and perimysium. d. The A-band under polarized light is called birefringent

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13. Concerning the sarcoplasmic reticulum in skeletal muscle, the following are correct EXCEPT: a. The primary role is to control interaction between actin and myosin b. The sarcotubules contain ATPase enzyme c. The terminal cisternae contain calsequestrin protein d. It does not function in cessation of muscle contraction 14. The following are the order of the excitation-contraction coupling: a. Stimulation>release of calcium> inhibition of troponin-tropomyocin complex>attachment of actin and myocin>ATP is splitted>muscle contraction>breakdown of ATP>detachment od actin and myocin>muscle relaxation b. Stimulation>release of calcium>inhibition of troponin-tropomyocin complex>ATP is splitted>attachment of actin and myocin>muscle contraction> detachment of actin and myocin> breakdown of ATP> muscle relaxation c. Stimulation>release of calcium>inhibition of troponin-tropomyocin complex>ATP is splitted>attachment of actin and myocin>muscle contraction>breakdown of ATP> detachment od actin and myocin>muscle relaxation d. Stimulation> inhibition of troponin-tropomyocin complex > release of calcium >ATP is splitted>attachment of actin and myocin>muscle contraction>breakdown of ATP> detachment od actin and myocin>muscle relaxation 15. The following are true of muscle fatigue EXCEPT: a. May be caused by lactic acid that inhibit excitation-contraction coupling b. Occur when the muscle does not respond to a stimulus of the same degree c. Temporary decrease in the work capacity of the nerve of the skeletal muscle d. 1-2 minutes of loss of blood could lead to muscle fatigue 16. Regarding the production of muscle energy, the following are true EXCEPT: a. Both aerobic and anaerobic glycolysis can occur b. Creatine phosphate is the major energy reserve c. Prolonged fasting can cause loss of muscle d. Ca ions can also stimulate glycolysis 17. The following are true regarding the development of skeletal muscle fibers EXCEPT: a. They are developed from a mother cell called myoblast b. The first stage consist of spindle-shaped cells and myofibrils c. The second stage consist of multinucleated myotubes d. The third stage consist of the nuclei assuming a peripheral position 18. Concerning the smooth muscle, the following are true EXCEPT: a. Leiomyocytes can reach up to 500µm long in pregnant uterus b. They are only regulated by the nervous system c. Thick myofilaments in routine E.M are seen in between thin filaments d. The vital organelles are at the two poles of the nucleus 19. The following are true regarding the regulation of smooth muscle contraction EXCEPT: a. Myosin kinase leads to phosphorylation of actin filaments b. Calmodulin leads to activation of myosin kinase, thus muscle contraction c. Phosphatase enzyme split the phosphate that leads to muscle relaxation d. Increase of calcium increase excitability of muscle

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Module 5: Musculoskeletal System
20. The following are true of the physiological properties of smooth muscle EXCEPT: a. The action potential with plateau is one of the two types of action potential b. The smooth muscle fibers are capable of slow wave potential c. The smooth muscle fibers are capable as a pacemaker d. Vasopressin are capable of inhibiting the excitability of the fibers 21. The following are true concerning muscle denervation EXCEPT: a. Examples of cases are myasthenia gravis and poliomyelitis b. Posterior horn cell releases pathological discharge muscle fasciculations c. Hypersensitivity to acetylcholine could cause muscle fibrillations d. Produces long chronaxie in the aspect of its electrical response 22. Regarding the z-line it is a. located in the center of dark band b. located in the center of light band c. the functional unit of the skeletal muscle d. both (b) and ( c ) are correct 23. The main protein in the thick filament of the skeletal muscle fiber is a. myocin b. actin c. tropmyocin d. tropnin-c 24. During muscle relaxation , a. the cross bridges are attached to the actin active sites b. myocin binding sites on actin filaments are uncovered c. troponin-c tropomyocin complex covers the myocin binding sites on actin d. troponinT-tropomyocin complex covers the actin active sites 25. Sarcomere is, a. distance between 2 -z lines b. distance between two successive –zlines c. structural unit of the skeletal muscle d. distance between two successive H-zones 26. During muscle contraction , a. myocin filaments slide over actin filaments b. it is the actin filaments that slide on myocin ones c. Ca++ bind to troponin –C d. both ( b ) and ( c ) are correct 27. Muscle proteins responsible for its relaxation involve a. myocin b. actin c. tropomyocin d. troponin –C

2010/2011

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28. ATP is utilized by the skeletal muscle in a. sliding of actin filaments over myocin ones b. release of Ca++ from sarcoplasmic reticulum (SR ) c. restorage of Ca ++ in SR d. both ( a ) and ( c ) are correct 29. Motor end plate potential is a. A localized depolarization b. A propagating wave of depolarization c. developed in response to somatic nerve stimulation d. both ( a ) and ( c ) are correct 30. The natural skeletal muscle contraction is a. Tetanic contraction b. incomplete tetanic contraction c. Separate contractions d. both ( b ) and ( c ) are correct 31. In the simple muscle twich ( SMT ) a. the latent period equals 0.4 second b. the total twich time is 0.1 second c. the contraction period is the longest d. relaxation period equals 0.01 second 32. In the isometric muscle contraction there is a. No work is done b. Muscle tension is normal c. Muscle length is constant d. Both ( a ) and (c ) are correct 33. Warming of the skeletal muscle is associated with a. high force of contraction b. more Ca++ release from SR c. increased duration of contraction d. Both ( a ) and ( b ) are correct 34. Rapid successive skeletal muscle stimulation leads to, a. higher amplitude of contraction b. depleation of energy stores in the muscle c. Accumulation of lactic acid with muscle fatigue d. Both (b ) and ( c ) are correct 35. When a skeletal muscle is free loaded it a. becomes more streched during relaxation b. showes stronger contraction c. sluggish contraction occurs d. Both ( a ) and ( b ) are correct

2010/2011

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Module 5: Musculoskeletal System
36. In isotonic muscle contraction there is a. normal muscle length b. constant muscle tension c. increased muscle tension d. No work is done 37. In the smooth muscles ,there is a. well developed SR b. caveoli instead of T-tubule c. dense bodies d. Both ( b ) and ( c ) are correct 38. Regarding the smooth muscle, a. it has spiky action potential only b. its RMP equals -80 mv c. its action potential may be spiky or with plateau d. it utilizes more ATP than skeletal muscle 39. In the smooth muscle there is a. more myocin than actin filaments b. more actin than myocin filaments c. troponins like skeletal muscle d. Z- lines as in skeletal muscle 40. Incomplete tetanus turns into complete tetanus by a. warming b. cooling c. fatigue d. Both ( b ) and ( c ) are correct 41. Muscle atrophy my occur due to a. lesion of the motor nerve supply b. immobilization of the muscle c. direct trauma to the muscle d. both ( a ) and ( b ) are correct 42. Rigor mortis is, a. A state of post mortim muscle softening b. A state of muscle spasm just after death c. Of medicolegal importance d. both ( b ) and ( c ) are correct 43. Which of the following has the potential amplitude a. ventricular muscle b. visceral plain muscle c. skeletal muscle d. nerve cell

2010/2011

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44. All of the following obey all or none rule EXCEPT a. Single nerve fibre b. Single skeletal muscle fibre c. Motor unit d. Single smooth muscle fibre with no gap junctions UPPER LIMB 45. What is the first bone to ossificate? a. Humerus b. Phalanges c. Radius d. Clavicle 46. Regarding clavicle, the following are correct EXCEPT: a. The rough area laterally is for the attachment of coracoclavicular ligament b. The lateral third is flattened form above downward and curves backwards c. The conoid tubercle is on the smooth surface of the clavicle d. The medial segment is pulled upwards by the sternomastoid muscle 47. The following are true of the borders and angles of the scapula EXCEPT: a. The superior border presents a notch where suprascapular nerve passes b. The lateral border ends by the supraglenoid tubercle c. The inferior angle lies opposite to the 7th rib d. The angle that lies on the 2nd rib is almost a right angle

2010/2011

48. Concerning the humerus, the following are true EXCEPT: a. The groove on the posterior aspect lodges the radial nerve and the profunda brachii vessel b. The groove on the posterior aspect of medial epicondyle carries the ulnar nerve c. The brahioradialis takes origin from the length of lateral supracondylar ridge d. Axillary nerve passes around the surgical neck of the humerus 49. These are the nerve supply of the shoulder joint EXCEPT: a. Axillary b. Pectoral c. Musculocutaneous d. Suprascapular 50. The following are true of the axillary artery EXCEPT: a. Axillary vein is located medially to it at its 1st part b. If it is ligated proximal to the humeral branch, the blood flow can be re-established c. A deltoid branch in thoracoacromial artery of the axillary artery shares in an anastomosis d. It is present in the axilla 51. Regarding arterial supply of the hand, the following are true EXCEPT: a. Radialis indicis supplies the radial side of the thumb b. Superficial palmar arch are completed by radial artery c. Deep palmar arch lies 3cm proximal to the superficial palmar arch d. Palmar metacarpal arteries join in the arterial supply of the hand

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52. These arteries will establish the circulation if there is ligation of brachial artery EXCEPT: a. Posterior ulnar collateral artery b. Ulnar artery c. Radial artery d. Interosseous recurrent artery 53. The course and relations of brachial artery are the following EXCEPT: a. Accompanied by two venae commitants b. Relatively superficial 3/4th of its course c. Related medially to the basilic vein d. Related laterally to the median vein only at the upper half of arm 54. The relations of axillary artery are the following EXCEPT: a. 1st digitation of serratus anterior at the posterior of 1st part of the artery b. Medial pectoral nerve at the medial aspect of the 2nd part of the artery c. Both of the pectoralis muscle at the anterior of the 2nd part of the artery d. Pectoralis major muscle are at the anterior of the 3rd part of the artery 55. The quadrangular space is bounded by all of the following EXCEPT: a. Teres minor b. Teres major c. Long head of biceps d. Long head of triceps e. Surgical neck of the humerus 56. Regarding the biceps brachii, one is INCORRECT: a. Has long head attached to the supraglenoid tubercle b. Has short head attached to the tip of the coracoid process c. Has a tendon inserted into the radial tuberosity d. It flexes the elbow joint e. It is powerful supinator of the extended elbow 57. The nerve supply of the pectoralis major is by _________ nerve/s a. Medial pectoral b. Lateral pectoral c. Both a and b d. None of the above 58. A patient presents in her fourth pregnancy with a history of numbness and tingling in her right thumb and index finger during each of her previous three pregnancies. Currently, the same symptoms are constant, although generally worse in early morning. Symptoms could be somewhat relieved by vigorous shaking of the wrist. Neurologic examination revealed atrophy and weakness of the abductor pollicis brevis, the opponens pollicis, and the first two lumbrical muscles. Sensation was decreased over the lateral palm and volar aspect of first three digits and lateral palm when the wrist was held in flexion for 30seconds. The symptoms suggest damage to which of the following? a. Musculocutaneous nerve b. Median nerve c. Ulnar nerve d. Radial nerve

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Module 5: Musculoskeletal System
59. The lesser tuberosity of the humerus give attachment to: a. Teres minor b. Teres major c. Supraspinatus d. Infraspinatus e. Subscapularis 60. The following tendon cross the carpal tunnel EXCEPT a. Flexor carpi ulnaris b. Flexor digitorum superficialis c. Flexor digitorum profundus d. Flexor pollicis longus 61. The following structure pass deep to the extensor retinaculum EXCEPT a. Abductor pollicis longus b. Extensor pollicis brevis c. Brachioradialis d. Anterior interosseous artery e. Posterior interosseous nerve 62. Which muscle will compensate in part for the paralysis of supinator muscle? a. Extensor carpi ulnaris b. Anconeus c. Biceps brachii d. Brachialis 63. During its course in the upper limb, the median nerve lies: a. In front of lateral epicondyle of humerus b. Medial to brachial artery in cubital fossa c. Against spiral groove of humerus d. Against surgical neck of humerus e. Superficial to flexor retinaculum f. Behind medial epicondyle of humerus 64. The only muscle of upper limb that has pelvic origin is a. Serratus anterior b. Pectoralis major c. Subscapularis d. Latissimus dorsi e. Teres major 65. Anastomosis around the scapula connects subclavian artery with: a. First part of axillary artery b. Second part of axillary artery c. Third part of axillary artery d. Brachial artery

2010/2011

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Module 5: Musculoskeletal System
66. Rotator cuff muscles are composed of the following EXCEPT a. Teres major b. Teres minor c. Supraspinatus d. Subscapularis e. Infraspinatus 67. Concerning long thoracic nerve, all are correct EXCEPT a. Supplies serratus anterior muscle b. Branch of posterior cord of brachial plexus c. Its root value is C5, 6, 7 d. Cutaneous to the lateral wall of thorax e. It descends to thoracic wall LOWER LIMB 68. What is the longest and strongest bone in the body? a. vertebrae b. humerus c. femur d. tibia 69. What is the largest sesamoid bone in the body? a. patella b. clavicle c. hip bone d. radius

2010/2011

70. All are true except: a. Peroneus longus support the medial longitudinal arch of the foot b. Tranverse arch seen at the tarso-metatarsal region c. Plantar aponeurosis strongly binds anterior and posterior pillar together d. Lateral longitudinal arch is made up of the calcaneus, cuboid, lateral two metatarsal 71. All are the functions of the arches except a. spring for easy propelling movement b. distribution of body weight on several points c. protect the sciatic nerve from injury d. protection of the structures at the sole of the foot 72. All are the contents of femoral sheath except a. femoral nerve b. femoral vein c. femoral artery d. lymph nodes

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73. All are true except a. profunda femoris artery give lateral circumflex femoral artery, medial circumflex femoral artery, and perforating branches b. profunda femoris artery ends as fourth perforating artery c. lateral circumflex femoral artery give ascending , descending and tranverse branches d. medial circumflex femoral artery give ascending, descending and tranverse branches 74. The posterior wall of adductor (subsartorial canal) a. sartorius b. vastus lateralis and quadriceps femoris c. pectineus d. adductor magnus and adductor longus 75. What is boundaries of greater sciatic foramen? a. greater sciatic notch, sacrotuberous ligament, sacrosinous ligament b. piriformis muscle, quadratus femoris c. superior and inferior gemellus muscles d. sciatic nerve and posterior cutaneous nerve of thigh 76. What is the nerve supply for gemellus inferior muscle and root value? a. nerve to obturator internus (L5,S1,S2) b. nerve to quadratus femoris (L3, L4) c. pudendal nerve (S2,S3,S4) d. nerve to quadratus femoris (L4,L5,S1) 77. Superior gluteal artery is the continuation of a. anterior division of the internal iliac artery b. posterior division of the external iliac artery c. posterior division of the internal iliac artery d. anterior division of femoral artery 78. All are true except a. medial end of superior extensor retinaculum is attached to lower part of the tibia b. inferior extensor retinaculum is a Y- shaped band lies on dorsum of foot c. flexor retinaculum is pierced by the lateral calcanean vessels and nerves d. tibialis posterior pass under the flexor retinaculum 79. All are true about plantar aponeurosis except a. maintain the tranverse arch b. attached posteriorly to both tubercles of calcaneus c. protect the underlying vessels and nerves d. dense sheet of fibrous tissue 80. All are involve in trochanteric anastomosis except a. inferior gluteal artery b. inferior branch of superior gluteal artery c. ascending branch of medial circumflex femoral artery d. tranverse branch of lateral circumflex femoral artery

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81. All the following are correct regarding the relations of femoral arteries EXCEPT a. Lateral – femoral nerve b. Posterior – psaos major, pectineus, adductor magnus and posterior wall of rectus sheath c. Medial – inguinal lymph nodes group d. Anterior - skin, superficial fascia, deep fascia,& anterior wall of femoral sheath 82. Great saphenous vein receives all of the following veins before entering into saphenous opening EXCEPT a. Epigastric vein b. Popliteal vein c. Pudendal vein d. Superficial circumflex iliac vein 83. All of the following are branches of profunda femoris artery which share in some anastomosis in lower limb EXCEPT a. Tranverse branch of lateral circumflex femoral artery b. Descending branch of lateral circumflex femoral artery c. Acetabular branch of medial circumflex femoral artery d. Ascending branch of medial circumflex femoral artery e. First perforating artery of profunda femoris artery 84. Below shows relations of politeal artery. Which of the following is INCORRECT? a. At upper part of popliteal fossa, popliteal vein and tibial nerve lateral to artery b. At lower part of fossa, after cross superficial to artery whole course, vein lies between artery and nerve c. At lower border of popliteus muscle, artery will terminate to anterior and posterior tibial artery d. Popliteal artery is the superficial structure in popliteal fossa (if see from posterior view) 85. Varicose vein is an engorged, dilated vein with blood. What is the cause of this varicose vein? a. Weak valves congested the vein b. Chemical mediator reactions c. Decrease oxygen concentration in venoule blood d. Gravitational pull 86. All the following are branches of dorsalis pedis artery, EXCEPT a. First plantar metatarsal artery b. First dorsal metatasrsal artery c. Arcuate artery d. Plantar metatarsal arteries 87. All the following are the correct match of artery and its continuation artery after termination EXCEPT a. Peroneal artery – calcanean artery b. Posterior tibial artery – medial and lateral plantar arteries c. Anterior tibial artery – arcuate artery d. Popliteal artery – anterior and posterior tibial artery

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Module 5: Musculoskeletal System
88. All the following flexors of thigh joint are supplied by femoral nerve EXCEPT a. Psaos major b. Illiacus c. Rectus femoris d. Sartorius

2010/2011

89. All the following are muscles originate from area between pubic tubercle and ischial tuberosity EXCEPT a. Gracilis b. Adductor longus c. Adductor brevis d. Adductor magnus (pubic part) e. Pectineus 90. What is the function of Gluteus Maximus and Tensor Fascia Lata exertions on iliotibial tract? a. Maintain knee in extended position b. Important during walking c. Maintain shape of the thigh d. Allow flexion of knee joint 91. Which of the following muscle passes through Greater Sciatic Foramen? a. Obturator internus b. Gemellus inferior c. Piriformis d. Quadratus femoris e. Gemellus superior

b. a. c. d.

92. Above is an ischial tuberosity diagram with its compartment. Which of the following is wrong? a. Semimembranosus b. Semitendinosus & Biceps Femoris (short head) c. Subcutaneous d. Adductor Magnus (Ischial part)

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Module 5: Musculoskeletal System
VERTEBRAE 93. All are true about vertebrae column except a. the thoracic and cervical are termed secondary curves b. there are 33 vertebrae assuming that 4 coccygeal vertebrae c. lumbar curve is more marked in female than male d. C1 is known as atlas

2010/2011

94. All true typical vertebrae and ossification except a. each vertebrae has body that facing anteriorly and vertebaral arch facing posteriorly b. secondary center of ossification appear at puberty c. primary ossification start after 7 months d. each arch has 2 pedicle, 2 laminae, a spinous process 95. “ X are developed by endochondral bone ossification, occurs in pre existing model cartilage’’. Which of the following refer to the X? a. clavicle b. skull vault c. vertebrae d. humerus 96. The vertebral column is developed from the Y. Y is, a. dermatome b. hyaline cartilage c. membrane d. para axial mesoderm BIOMECHANICS 97. Joint stability is maintained by the following except a. bones b. ligaments c. rough surface of bone d. muscles 98. Which of the following not involve in maintaining stability of the vertebaral column? a. IV disc b. facet joint c. number of vertebrae d. ligaments 99. “ IV disc in vertebral column do not act as shock absorber”.This statement.. a. true b. false

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Answers for MCQ 99
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. C B D B d D D D B B D A D C C D B C A D B B A D B 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. D C D D A B D D D D B D C B D D D D D D B D C B B 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. A A B D C E C B E A C C B D C A B C A A C A D D A 76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. 93. 94. 95. 96. 97. 98. 99. D C C A D B B C D A D C A E A C B A C D D C C B

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1. Tabulate the differences between the types of cartilage. Cartilage Hyaline Elastic Perichondrium Covered by perichondrium Always covered by except inside joint cavities perichondrium ECM - Glassy, translucent - very large number of - Fibers has same refractive interlacing elastic fibers index with ground substance - demonstrate by orcein and V.V.G. stains

Types of fibers Chondrocytes

Number of chondrocytes/ capsule Sites

Mainly type II collagen and few elastic fibers - present inside lacunae surrounded by capsule - at periphery, young chondrocytes are present underneath perichondrium - chondrocytes are scattered 1-8

Abundant elastic fibers + type II collagen - Chondrocytes are numerous

White Fibro Never covered by perichondrium Contains thick bundles of type I collagen fibers running in different directions but sometimes parallel and separated by narrow bands of non-fibrous matrix Abundant type I collagen + few type II - rounded chondrocytes lie in rows in narrow bands of non-fibrous matrix

1-3

1-2

Significance

1. skeleton of the embryo 2. epiphyseal plates in growing age 3. costal cartilages 4. nose, larynx, trachea, and bronchi 5. articular surface of all synovial and cartilaginous joints - Firm but flexibles - Present of cell nest

1. ear pinna 2. external auditory meatus 3. cuneiform and caorniculate cartilages in the larynx 4. epiglotis

1. intervertebral disc 2. symphysis pubis 3. temperomandibular joint 4. sternoclavicular joint

- fresh elastic cartilage has yellowish color caused by elastin in elastic fibers - flexible and resilient

- great strength with flexibility and rigidity - never covered by perichondrium as it merges into surrounding dense connective tissue of capsule and ligaments of joints

2. Discuss mechanism of bone remodeling. It means continuous renewal of bone, which is a balanced continuous state of bone resorption and simultaneous replacement by new bone formation. Bone remodeling is important for replacement of immature bone to mature bone and maintenance of bone structure and shape throughout life.

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3. Describe the biochemical composition of cartilage and synovial fluid (GAG): i. Collagen ii. Proteoglycans iii. Glycoprotein

2010/2011

i. Collagen Collagen is largely presented as a triple helix made up of three polypeptides (tropocollagen). In each of three individual collagen chains (polypeptides)of tropocollagen, the triplet Gly-X-Y is constantly repeated in the sequence i. e., every third amino acid in such sequences is a glycine, with the X position often being occupied by Pro and the Y position by Hyp. In triple helices, every third residue lies on the inside of the molecule, where there is only room for glycine residues. [FUNCTIONS] The hydroxyproline residues stabilize the triple helix by forming hydrogen bonds between the chains, Strength of collagen comes from these Hbonding between chains. While the hydroxyl groups of hydroxylysine are partly glycosylated with a disaccharide (–Glc–Gal) and help linking tropocollagen molecules together ii. Proteoglycans These are macromolecules found in the ECM or cell surface, containing up to 95% carbohydrates. Basic unit of proteoglycans is called aggrecan or proteoglycan monomer, consist of core protein with covalently attached GAGs. Proteoglycans contain a long strand of hyaluronic acid to which link proteins are attached non-covalently. In turn, link proteins interact non-covalently with core protein molecules. However, GAGs are attached covalently to core protein by glycosidic bonds between sugar reisdue and OH of serine. The GAGs attached to core protein are chondroitin sulphate (mainly), keratan sulphate, heparan sulphate & dermatan sulphate. iii. Glycoprotein Glycoproteins are proteins that have oligosaccharides chain (one or several) attached covalently to polypeptide backbone. The carbohydrates moieties are smaller and more structurally diverse than GAGs of proteoglycans. Carbohydrate units may be O-linked (sugar attached by a glycosidic link to the OH of serine or threonine) or N-linked (sugar attached to NH2 group of asparagines).Carbohydrate may constitute from 1-7% of glycoproteins. The sugar units in glycoprotein is N-acetyl amino sugar (e.g. N-acetyl glucosamine or N-acetyl galactosamine), hexose (e.g. mannose or galactose), L-Fucose (6-deoxy-L-galactose) and sialic acid. p/s: In examination, please use complete or full names and not short form… 4. Describe the role vitamin D, calcium and phosphorus in bone metabolism. Vitamin D helps in calcium and phosphorus absorption. Meanwhile, excess phosphorus in form of phosphate will inhibit calcium absorption. When serum calcium level increase, the level of hormone involved in activation of vitamin D3 will decreased and calcium absorption is diminished.

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5. Compare between compact bone and cancellous bone.

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6. What is meant by resting membrane potential? RMP is potential difference created across cell membrane by metabolic process of the fibre during rest 7. Enumerate the differences between an axon and a dendrite in histological structure. Differences between axon and dendrite Axon Dendrite Single process Single or multiple processes Cylindrical Tapering to one end Not branched except at its termination or Has many branches collaterals Originate from axon hillock Originate from any part of perikaryon May be covered by sheaths No sheaths Does not contain Nissl’s granules Contain Nissl’s granules Centrifugal impulse Centripetal impulse transmission

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8. What is the importance of sodium-potassium pump?’ Importance of Na+/K+ pump  Maintain Na+/K+ concentration gradients across cell membrane  Establish negative electrical potential inside the cells – helps to transmit signal throughout nervous system  Maintain normal level of intracellular K+ - necessary for protein metabolism  Keeps osmotic equilibrium to maintain cell volume 9. What is meant by temporal summation? Temporal summation is application of multiple subthreshold stimuli can be summated to give a response (when reaching firing level) [pg 63]

10. Label (1) ______________________ (2) ______________________ (3) ______________________ Ans: (1) Rheobase (2) Utilization time (3) Chronaxie 11. What is the relation between the duration and the excitability? The more excitable is the tissue, the less are the intensity, the shorter the duration 12. Compare between the supernormal phase and subnormal phase. Comparison Supernormal phase Subnormal phase Threshold to stimulate Decreased Increased Nerve excitability Increased Decreased Coincides with After depolarization After hyperpolarization

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13. Compare between the uses of energy during rest and during activity. Comparison [pg 73] During rest During activity - Maintain polarizaed state of the Energy expenditure is doubled to restore membrane polarized state of the membrane. - Maintain ionic composition across cell Oxygen consumption is increased. membrane - Na/K pump mechanism derives energy from breakdown of ATP 14. a) b) Ans: Give a short account on Myelinated nerve fibres in CNS Unmyelinates nerve fibres in PNS (a) Myelinated nerve fibres in CNS - Enveloped by myelin sheaths ONLY - Schwann cells are absent in CNS - Oligodendrocytes form myelin sheaths (b) Unmyelinated nerve fibres in PNS - Axons are enveloped by Schwann cell sheaths ONLY - They are usually in diameter - Single Schwann cell envelopes multiple segments of different axons

15. What is meant by action potential? Action potential is the electrical charges accompanied by wave of depolarization… 16. Enumerate the functions of skeletal muscle: 1. They move the body as a whole part of it 2. They maintain the body posture by their tonic contraction and muscle tone 3. Generate heat by contraction which maintains the body temp. 4. Stabilize and strengthen the joints of the skeleton by their contraction. (pg.92) 17. Tabulate the difference between slow muscle fibers(Type 1) and fast muscle fibers(Type 2): Slow muscle fibers (Type 1) Fast muscle fibers (Type 2) Thin fibers Thick fibers - Large amounts of myoglobin - Absence of myoglobin - Numerous blood capillaries - Few blood capillaries - Increasing number of mitochondria - Few mitochondria - Extensive reticulum - Large amounts of glycolytic enzymes - Longer latent period - Short latent period - Contract slowly - Contract rapidly - Fatigue slowly - Fatigue easily Maintain body posture against gravity Better at generating burst of speed and force Eg: back muscle and soleus muscle in marathons Eg: A sprinter and bicycle for hours (pg.92-93)

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Give a short account on the nerve supply of the skeletal muscle: Nerve-operated and under the control of CNS Contracts when their motor nerve is intact Motor nerve fibers reach the skeletal muscle from their anterior horn cells in the grey matter of the spinal cord - If the nerve supply is cut, degeneration of muscle with: o Complete loss of function o Paralysis (pg. 94) 19. Give a short account on the mechanism of neuro-muscular transmission: - When an action potential arrives at the axon terminal, calcium channels open and there will be influx of Ca2+ from ECF into the membrane of nerve terminals. - This will cause vesicles that contain the neurotransmitters to attach to the membrane of nerve fiber. - The vesicular membrane will fuse with the nerve cell membrane. - Acetycholine are excocytosed into the synaptic cleft. The acetycholine then diffuses and binds to acetycholine receptors at the motor end plate. - These ligand-gated channels then open, and allow rapid influx of Na2+ ions to the interior of the muscle which will excite the generation of action potential. (pg. 98) 20. What happens when sodium ions enter the muscle fiber? It decreases the membrane potential in the local area of the end plate which will produce local end plate potential (partial depolarization of the membrane). (pg. 99) 21. What happens to acetycholine after its release? It is rapidly destroyed (after one millisecond) by the acetyl cholinesterase enzyme in the cleft. This short time is sufficient for acetylcholine to excite the muscle fibers. The rapid hydrolysis of acetylcholine prevents re-excitation of the muscle fibers after recovery from the previous action potential. (pg 99-100) 22. Tabulate the types of muscular contraction: Isotonic contraction Light/moderate Load Muscle shorten Length of contraction Load moves Movement of load There is work done Work 75% Conversion to heat

Isometric contraction Heavy Muscle does not shorten Load does not move No work done 100% (pg 104-105)

23. Enumerate the sources of ATP generation in muscles and give a short account on each one: 1. Glycolysis: two high energy phosphates are catalyzed in 2 reactions calalyzed by phosphoglycerate kinase and pyruvate kinase. Both aerobic and anaerobic can occur. 2. Citric acid cycle: one high energy phosphate is generated by succinyl thiokinase step in aerobic conditions only. 3. Oxidative phosphorylation: greatest source of ATP in aerobic conditions

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4. Creatine phosphate: creatine + ATP ↔ADP + creatine phosphate. Creatine phosphate is a major energy reserve which is a reversible reaction. 5. Adenylyl kinase : myosin ATPase ATP muscle contraction ADP + Pi AMP adenyl kinase ADP (pg. 110)

24. Why do smooth muscles have a greater capacity for regeneration? - Smooth muscle fibers respond to the increased demands by undergoing compensatory hypertrophy along with skeletal and cardiac muscle fibers. - They can retain the capacity for mitosis and respond to requests by hyperplasia. - Pericytes along the course of small blood vessels can also form new smooth muscle fibers. (pg. 117) 25. Tabulate the two types of smooth muscle: Visceral smooth muscle (unitary) Multi-units smooth muscle GIT, urinary tract, genital tract, blood Site Muscle lining the b.v., ciliary muscle, iris vessels of eye, piloerector muscle In the form of bundles and presence of Characteristics Made of separate fibers gap junctions Syncytial fashion Contraction Non synsytial fashion Non-nervous stimuli Controlled by Autonomic nervous system (pg. 118-119) 26. Compare skeletal muscle and smooth muscle (both histologically & physiologically). Skeletal muscle Smooth muscle

Striation Movement Site

Striated Voluntary 1. attached to skeleton 2. ocular muscle 3. muscle of face, tongue, pharynx, diaphragm & upper 2/3 of oesophagus

Stimulus/i

nerve impulse

Innervations LM: Shape LM: Nucleus LM: Sacroplasm

central nervous system long, cylindrical cell (fiber) multinucleated, pale, elongated oval, periphery Scanty, eosinophil; filled with

non-striated Involuntary Visceral smooth muscle: 1. digestive tract 2. urinary tract 3. genital tract 4. many blood vessels Multi-units smooth muscle: 1. muscle lining blood vessels 2. ciliary muscle & iris of eye 3. piloerector muscle of hair 1. nerve impulse 2. hormone (non-nervous) 3. cytokine (non-nervous) autonomic nervous system elongated, fusiform (spindle) cell single, pale, oval, central abundant, homogenous eosinophil 23

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numerous longitudinally oriented myofibrils Thick & thin myofilaments Lesser than skeletal muscle Fibers are parallel to each other with the same registration of light and dark bands of adjacent fibers Present (part of thin filament) Z-lines (presence of alphaactinin) Absent Present Well developed Absent Absent Regular Present Present – small at junction between A and I bands Faster High Present ATPase enzyme

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Myofibrils Proportion of actin: myosin Arrangement of myofibrils

Thick & thin myofilaments Greater than skeletal muscle Group in bundles with irregular orientation, more or less oblique to long axis of the cell Lack of troponin Dense bodies (presence of alphaactinin) Present Present Not well developed Present May present Absent Absent Absent- caveolae instead Slower Small (only 1 ATP) Absent – calmodulin instead ATPase enzyme Myosin kinase Phosphatase Mainly extracellular fluid, in addition of sarcoplasmic reticulum in some smooth muscle Slower Long Spike potential & action potential with plateau -50Mv 10-50 msec

Troponin Attachment of thin filaments Presence of desmin Basal lamina covering sacrolemma Sacroplasmic reticulum Centrioles Gap junction Sacromere Triad of tubular system T-tubules Contraction-Relaxation Energy needed Troponin-C Enzymes involved

Source of calcium

Terminal cisternae of sarcoplasmic reticulum Faster Short Spike potential -90mV 1-5 msec 130 mV Absent Present More excitable Short Lesser than smooth muscle Faster

Calcium pump Period of contraction Action potential RMP Duration of spike potential Magnitude of action potential Rythmic contraction Tonic contraction Excitability Chronaxie Force of muscle contraction Cycling of the Myosin Cross-Bridges

Present Present Less excitable Long Greater than skeletal muscle Slower

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P/S: Don’t forget to include explanation especially if the comparison is physiologically (which you can refer to Module 5 page 342-343) 27. Compare electrical changes in skeletal muscles and nerves. Skeletal Muscle RMP -90mV Magnitude 130 mV Duration of action potential 1-5 msec Velocity of excitation wave 3-5 m/sec conduction Duration of after potential Longer

Nerve Fiber -70mV 105mV up to 120 m/sec (in thick myelinated nerve fibers) Shorter

28. Describe the structure and function of motor unit and motor end plate. Motor unit is an anterior horn cell together with its axon and the number of fibers it supplies (about 30-150 muscle fibers). Each motor unit obeys the all or non rule. When the anterior horn cell is stimulated, its entire muscle fibers contract but not all the motor units in a given muscle contract at the same time. Increase in intensity stimuli, increase number of active motor units, thus increase in intensity of response. Motor end plate is a site of junction between nerve and skeletal muscle fibers. It is a characteristic specialized nerve ending (effector, motor) by which a motor nerve fiber ends in a skeleton (striated) muscle. Each nerve fiber branches many times to stimulate several skeletal muscle fibers. This junction usually occurred at the fibers midpoint, so the action potential travels in both directions. The function of motor end plate is for the transmission of action potential of nerve fibers to skeletal muscle as an effector through neurotransmission or synapse. 29. Describe the molecular basis of muscular contraction and excitation-contraction coupling. Molecular basis of Muscular Contraction - Shortening or contraction of muscle occurs by sliding the thin filaments of the myofibrils over the thick filament. - During rest, troponin T – tropomyosin complex covers the binding sites for myosin heads on actin filaments, inhibit contraction. Binding of Ca2+ to Troponin C causes uncover of myosin binding sites as tropomyosin moves laterally. - The heads of myosin link to actin at a right angle, then swiveling of the myosin heads, followed by detaching and reattachment to the next linking site. - The thick and thin filaments of sarcomere will interdigitate causing shortening of Z-line and H-band widths until they both disappear. - Energy for muscle contraction is derived from breakdown of ATP. - The heads of myosin molecules have ATPase activity. Excitation-contraction Coupling - Stimulation of myelinated motor nerve supplying a skeletal muscle leading to generation of action potential, which spreads along both sides of the sarcolemma membrane. - The action potential spreads to the depth of the myofibrils via T-tubular system (extending from sarcolemma membrane).

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Release of calcium ions from lateral sacs of the sarcoplasmic reticulum and its diffusion to the thick and thin filaments. Binding of Ca2+ to troponin C causing lateral movement of tropomyosin that uncover the binding sites of myosin heads on actin filaments. ATP is splitted to supply energy for contraction. Sliding of thin filaments over thick filaments due to formation of cross linkages between myosin and actin leading to muscular contraction. Every sliding of filaments will cause 1% shortening of muscle length. More and more shortening is obtained by disconnection, swiveling and reconnection of myosin heads to the binding sites on actin filaments. Active reuptake of Ca2+ by sarcoplasmic reticulum to be stored for the next action potential. Energy is needed for both relaxation and contraction. Once the reuptake of calcium occurred, the interaction between myosin and actin stops as tropomyosin moves medially to cover the binding sites of myosin heads over actin filaments and muscular relaxation occurs.

30. What are the factors sharing in stability of shoulder joint: Bony factor Ligamentous factor  The labrum glenoidale  Labrum glenoidale that deepens the  Coraco-acromial shallow glenoid cavity. ligament as bridges  Coraco-acromial arch over bony arch. that prevents the upward dislocation of the head of humerus.

Muscular factor  Rotator cuff muscles (SITS) adhere to capsule of joint.  Splinting effect of triceps and biceps muscles.  Long head of biceps prevents upward dislocation. (pg. 195)

31. Tabulate the differences between the small joints of the hand: Intercarpal Carpometacarpa Intermetacarpa Metacarpophalangea joints l joints l joints l joints Typ Synovial Plane, synovial Plane, synovial Ellipsoid, biaxial, e EXCEPT 1st synovial carpometacarpal (saddle, biaxial, synovial) Site Between Distal row of Between Between metacarpal carpal carpal bones and adjacent parts bones and the bones metacarpal of the bases of proximal phalanges (proximal bones the medial 4 and distal fingers form Sshape transverse intercarpals )

Interphalangea l joints Hinge

Between the phalanges of each finger

(pg.202-203)

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32. Tabulate the difference between radial and ulnar artery: Radial artery Ulnar artery As one of the two terminal branches of Beginning As one of the two terminal branches of brachial a. opposite the neck of radius brachial a. opposite the neck of radius Smaller Size Larger o Descends in the forearm Course o Descends in the forearm o Passes anterior of radius o Lies superficial to the flexor o Lies superficial at wrist retinaculum o Reaches the anatomical snuff o Enters the hand and continues box where it lies on scaphoid as superficial palmar arch bone o Enters between two heads of the first dorsal interosseous muscle o Continues in the hand as depp palmar arch o Radial recurrent Branches o Anterior and posterior ulnar o Muscular branches recurrent o Nutrient artery to radius o Common interooseous o Ant and post carpal o Nutrient artery to ulna o Superficial palmar branch o Carpal branches o Forst dorsal metacarpal branch (pg. 173-174) 33. 1.    2. Give a short account of the anastomosis around the surgical neck of humerus: Anastomosis between: Ant circumflex humeral artery of the 3rd part of axillary artery Post circumflex humeral artery of the 3rd part of axillary artery Deltoid branch of the thoracoacromial artery of the 2nd part of axillary artery If axillary artery is ligated distal to humeral and subscapular branches, blood flow can be reestablished by these branches and profunda brachii. 3. If axillary artery is ligated distal to profunda brachii and sup ulnar collaterall arteries, blood flow can be re-established by: - Inferior ulnar collateral - Ulnar artery - Radial artery - Interosseous recurrent artery (pg. 157) 34. Give a short account of the veins of the upper limb: Superficial venous system  Palmar and dorsal digital veins on  respective surfaces of the digits:  - join to form dorsal metacarpal veins that anostomose to form dorsal venous arch  Cephalic vein: lateral continuation of dorsal  venous arch: - ascends along radial side of forearm to

Deep venous drainage Deep venousarcades in the hand 2 veins accompanying an artery(venae comitantes) of radial, ulnar and brachial arteries The venae comitantes of radial and ulnar arteries join to form the vena comitantes of the brachial artery, which unite the 27

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cubital fossa - passes in deltopectoral groove - terminate by piercing clavipectoral fascia and drain into axillary vein Basilic vein: medial continuation of dorsal venous arch: - ascends along ulnar side of the forearm - pierces deep fascia in arm and unites with brachial vein to form axillary vein Median cubital vein in cubital fossa: - passes oblique across fossa to connect cephalic and basilica vein. - used for IV injections

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basilic vein to form the axillary vein

(pg.192) 35. Label the diagram below with its cutaneous branch of specific nerve supply

1) 2) 3)

36. 37. 38. 39. i)

ii) iii) iv) v)

Enumerate structures that passing superficial to flexor retinaculum. Give an account on arterial anastomosis around the elbow joint. What are the causes of winging scapula? Fill in the blanks with suitable words Two examples of the synovial ball and socket joints a) _____________________ b) _____________________ Deep palmar arch is formed mainly by _______________while superficial palmar arch is formed mainly by _________________. Axillary artery is a continuation of _______________artery at ___________border of _______________rib. The ______________________muscle divides the axillary artery into three parts. Two structures that pass around the surgical neck of humerus are a) ______________________ b) ______________________

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Answers (for Q 35 - 39) 35. 1) Median nerve 2) Ulnar nerve 3) Radial nerve 36.      Structure superficial to flexor retinaculum Ulnar nerve Ulnar vessel Cutaneous branch of ulnar nerve Cutaneous branch of median nerve Tendon of palmaris longus

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37. Anastomosis around elbow joint (draw a diagram – easy to illustrate)  In front of medial epicondyle – Anterior branch of inferior ulnar collateral a. (brachial a.) anastomosise with anterior branch of ulnar recurrent a. (ulnar a.)  Behind medial epicondyle – Posterior branch of inferior ulnar collateral a. and superior ulnar collateral a. (brachial a.) anastomosise with posterior branch of ulnar recurrent a. (ulnar a.)  In front of lateral epicondyle – Anterior branch of descending profunda brachii a. (brachial a.) anastomosise with radial recurrent a. (radial a.)  Behind lateral epicondyle – Posterior branch of descending profunda brachii a. (brachial a.) anastomosise with interosseous recurrent a. (ulnar a.) 38. Winging scapula is due to injury of long thoracic nerve (nerve to serratus anterior) which lead to paralysis of serratus anterior muscle. 39. Fill in the blank. i) Shoulder joint, hip joint ii) Radial artery, ulnar artery iii) Subclavian, outer, first iv) Pectoralis minor v) Axillary nerve, posterior circumflex humeral artery 40. Learn all the Laws 22 below:Law 1: Anterior compartment of thigh is either flexor of hip joint or extensor of knee joint or either both (EXCEPT for Sartorius which its action is both flexions of hip and knee joints). Law 2: All 3 adductors (Adductor Magnus, Adductor Brevis & Adductor Longus EXCEPT for harmstring part of Adductor Magnus) share 3 common movements which are; flexion, adduction & lateral rotation of hip joint. Law 3: Main extensor of hip joint is Gluteus Maximus and it is supplied by Inferior Gluteal Nerve. Law 4: Abductor of hip joints are Gluteus Medius, Gluteus Minimus & Tensor Fascia Lata which also share the same nerve; Superior Gluteal Nerve. Thus, these muscles are named “Muscle during Walking”. Law 5: Anterior fibers of Gluteus Medius and Minimus causing Medial Rotation of hip joint.

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Law 6: Two muscle inserted to Iliotibial tract; Gluteus Maximus (3/4) and Tensor Fascia Lata. Law 7: According to Module 5, we have 5 small rotators of hip joint which are; Piriformis, Gemellus Superior, Gemellus Inferior, Obturator Internus and Quadratus Femoris (some books add obturator externus). The action of these muscles can be determined by their name. Law 8: All small lateral rotators (2 Gemelli, Piriformis Obturator internus + Obturator externus) are inserted at Greater Trochanter EXCPET Quadratus Femoris. Law 9: Specially for Piriformis - origin from sacral vertebrae, thus supplied also by sacral nerves (ant rami 1st and 2nd) Law 10: Posterior compartment of thigh is flexor of knee joint (EXCEPT Hamstring part of Adductor Magnus) and extensor of the hip joint (ALL). Law 11: Both Semis (Semimembranosus & Semitendinosus) share EXTRA movement; medial rotation of the knee while Biceps Femoris does the opposite that is lateral rotation of the knee. Law 12: According to Module 5, all anterior compartment of leg do dorsiflexion (extension of foot) EXCEPT Extensor Hallucis Longus (+ Extensor Digitorum Brevis). Law 13: All Tibialis do inversion of foot + 2 Flexors of leg (Flexor Digitorum Longus & Flexor Hallucis Longus). Law 14: All Peroneus do eversion of foot. Law 15: Origin of muscle at Anterior surface of Fibula: Extensor Hallucis Longus, Extensor Digitorum Longus & Peroneus Tertius Law 16: As Peroneus Longus and Brevis are Lateral compartment, they share the same site of origin that is Lateral surface of Fibula. Law 17: Posterior surface of Fibula placed origin sites for Flexor Hallucis Longus (Lateral to Medial Crest) and Tibialis Posterior (Medial to Medial Crest). Law 18: Posterior surface of Tibia placed oringin sites for Flexor Digitorum Longus & Tibialis Posterior. Thus, we can conclude that, All Posterior compartment of leg originate from posterior surface of Tibia we Fibula. Law 19: Base of distal phalanx of thumb is insertion site for Extensor Hallucis Longus (Dorsally) & Flexor Hallucis Longus (Plantarly). Law 20: Base of 1st metatarsal and medial cuneiform bone are insertion sites of Tibialis Anterior (Dorsal) & Peroneus Longus (Laterally). Law 21: Base of 5th metatsrsal bone: Peroneus Tertius (Dorsum) & Peroneus Brevis (Tubercle) Law 22: Distal phalanges of 4 lateral toes are insertions of Extensor Digitorum Longus (through Extensor Expension) & Flexor Digitorum Longus (Plantar). 41. State the boundaries of femoral triangle. Lateral boundary: Medial border of sartorius Medial boundary: Medial border of adductor longus Base: Inguinal ligament Apex: Overlap between medial border of sartorius and adductor longus 42. X is the content of lateral compartment of the femoral sheath. State X and its course. X is femoral artery. - continuation of external ilac artey -Descends across the femoral triangle to its apex and continues in the adductor canal .It terminates at the end adductor canal by passing through adductor hiatus.

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43. State the insertion for SGS and the nerve supplying them. Upper part of medial surface of tibia Sartorius- anterior division of femoral nerve Gracilis- anterior division of obturator nerve Semitendinosus- tibial component of sciatic nerve 44. State three muscles in the gluteal region and give one action for each muscle. Gluteus maximus- extension and lateral rotation of the thigh Gluteus medius- abduction of hip joint Gluteus minimus- abduction of hip joint 45. Y passed through the lower part of greater sciatic foramen below the piriformis. State Y and its root value. Y is sciatic nerve ( L4,5,S1,2,3) 46. State two parts of Y and give one example for each part. Y consist of common peroneal part and tibial part. Common peroneal – Short head of biceps Tibial part – semitendinosus 47. Quadriceps femoris consist of four muscles. State the four muscles and the main action of quadriceps femoris. Rectus femoris, vastus lateralis,vastus medialis, vastus intermedius main extensor of knee joint 48. State two muscles that pass on the groove at the back of medial malleolus of tibia. Give two actions for each muscle. Tibialis posterior –inversion, plantar flexion Flexor digitorum longus- flexion of inter-phalangeal joints of lateral four toes, plantar flexion 49. The superficial venous drainage consists of small saphenous vein and V. Explain V, its course and tributaries. V is great saphenous vein. - ascends in front and above medial malleolus. -ascend along medial border of tibia to the back of medial side of knee. - continues on the medial aspect of the thigh to the saphenous opening,then pierces cribriform fascia to empty in femoral vein. - superficial epigastric,superficial circumflex iliac and superficial external pudendal veins 50. State five structures that present inside the knee joints and mention one structure that prevent hyperextension. Medial semilunar cartilage, lateral semilunar cartilage, anterior cruciate ligament, posterior cruciate ligament and popliteus tendon.

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51. State the course and relations of the posterior tibial nerve. 52. Explain one example of bone that maintains the joint stability.

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53. Explain the development of vertebral column Vertebral column is developed from the para axial mesoderm of embryo - Medial portion of myotomes is the sclerotome migrate medially to surround notochord - Each sclerotome is differentiated into cranial and caudal halves - Caudal halve of each sclerotome diffuse with cephalic halve to form mesenchymal vertebaral body. - Right and left halve fuse to form one vertebral body - Notochord degenerate in the region of vertebral body and in vertebral spaces enlarge to form nucleus pulbosus of the intervetebral disc. The surrounding mesenchyme give annulus fibrosis. - Mesenchymal give dorsal and lateral out growth on each sides - The dorsal form the mesenchymal neural arch and the lateral form membranous vertebral that transformed to cartilaginous in the cervical region.In lumbar region , the costal element form part of tranverse process. 54. Explain the development muscle of limbs. - Muscle of limb develop from myotomes and body wall mesenchyme that migrate into limb buds. - myotomes divided into… 55. State two congenital anomalies of vertebrae and muscle. Vertebral column- spina bifida, hemi vertebrae Muscle- agenesis, variations

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Q1. Types of cartilage and its sites A Hyaline cartilage B Elastic cartilage C White fibrocartilage

Skeleton of embryo Auricle of ear Epiglottis Symphysis pubis Nose Costal cartilage Cuneiform & corniculate cartilages in larynx Intervertebral disc Temporamandibular joint Articular surface of synovial and cartilaginous joints Epiphyseal plates External auditory meatus Sternoclavicular joint

Q2 A B C D E F G H

NERVE TISSUE Bipolar Stellate Pseudounipolar Pyramidal Pyriform Golgi type I Golgy type II Unipolar 1 2 3 4 5 6 7 8

SITE Olfactory mucosa of the nose Cerebral cortex Spinal ganglia Sympathetic ganglia Common in invertebrates Brain and spinal cord Purkinje cell layer

Q3. Epimysium Perimysium Endomysium a. Thin fibrous septa b. Dense connective tissue c. Delicate connective tissue sheets

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Q4. A B C D E F G H Q5. A B C D E F G H Q6. A B C D E F G H Q7. A B C D E F G H MUSCLE Teres major Pectoralis minor Supraspinatus Deltoid Subscapularis Rhomboideus major Teres minor Serratus anterior MUSCLE Flexor carpi ulnaris Pronator teres Flexor digitorum profundus Brachioradialis 3rd palmar interosseous Extensor carpi ulnaris Extensor carpi radialis longus Palmaris brevis NERVE SUPPLY Axillary nerve Median nerve Radial nerve Ulnar nerve Thoracodorsal nerve Dorsal scapular nerve Musculocutaneous nerve Long thoracic nerve DEFORMITY Ape hand Weakness of flexion of the arm Loss of lateral slop of the neck Partial claw hand Wrist drop Finger drop only Erb’s paralysis Klumpke’s paralysis 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 C5 C5, 6 C5, 6,7 C6, 7, 8 C5, 6, 7, 8 C7, 8, T1 C8, T1 C5, 6, 7, 8, T1 NERVE INJURY Ulnar nerve Radial nerve Musculocutaneous nerve Median nerve NERVE SUPPLY Suprascapular nerve Radial nerve Lower subscapular nerve Long thoracic nerve Axillary nerve Dorsal scapular nerve Medial pectoral nerve Thoracodorsal nerve NERVE SUPPLY Median nerve Radial nerve Musculocutaneous nerve Ulnar nerve Deep branch of radial nerve Anterior interosseous nerve Deep branch of ulnar nerve

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1 2 3 4 5 6 7 8

1 2 3 4 5 6 7 8

Superficial branch of ulnar nerve ROOT VALUE

Upper trunk of brachial plexus Lower trunk of brachial plexus Spinal accessory nerve Posterior interosseous nerve 34

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Q8. Type of joints: Shoulder joint Elbow joint Superior radio-ulnar joint Inferior radio-ulnar joint Radiocarpal joint Q9. Movement of shoulder joint: Lateral rotation Adduction Flexion Abduction Extension Q10. Anastomosis of elbow joint: Anterior branch of inferior ulnar collateral artery of brachial artery Anterior descending branch of profunda brachii artery of brachial artery Posterior branch of inferior ulnar collateral artery of brachial artery Posterior descending branch of profunda brachii artery of brachial artery Superior ulnar collateral artery a. b. c. d. e. Biceps brachii Supraspinatus Pectoralis minor Pectoralis major Posterior fibres of deltoid a. b. c. d. e. Polyaxial Ellipsoid Fibrous Hinge Pivot

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a. Interosseus recurrent of posterior interosseus artery of common interosseus artery of ulnar artery b. Nutrient artery to radius c. Posterior ulnar recurrent of ulnar artery d. Radial recurrent branch of redial artery e. Anterior ulnar recurrence from the ulnar artery

Q11. Movement of wrist joint: Flexion a. Extension b. Adduction c. Abduction d. Q12. Types of veins A B

Extensor carpi radialis longus Extensor digitorum Extensor carpi ulnaris Extensor digiti minimi

Superficial veins Deep veins

Great saphenous vein Femoral vein Popliteal vein Small saphenous vein

Q13. Anterior compartment 1 Pectineus 2 Quadriceps femoris 3 Psoas major 4 Sartorius 5 iliacus

a b c d e

ASIS (origin) Branches from lumbar plexus Powerful extensor of knee joint Flexion and adduction of thigh at hip joint Iliac fossa (origin)

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Q14. Nerve (root value,origin) and vessel (beginning and tributaries) 1 femoral nerve a lumbar plexus (L2,L3,L4) anterior divisions 2 posterior tibial nerve b internal iliac artery (posterior division) 3 superior gluteal artery c largest branch of lumbar plexus (L2,L3,L4) 4 femoral artery d continuation of medial popliteal nerve 5 obturator nerve e external iliac artery Q15. Muscles 1 Short head of biceps 2 Peroneus longus 3 Sartorius,gracilis,semitendinosus insert into 4 adductor hallucis 5 plantar interossei muscles

A B C D E

upper part of medial surface of tibia third layer of muscles of sole common peroneal part of sciatic nerve fourth layer muscles of sole musculocutaneous nerve

Q16. Development of bones, vertebrae and muscles 1 example of abnormal muscle a 2 vertebrae developed from b 3 example of abnormal vertebrae c 4 muscles developed from d 5 Clavicle e

kyphosis intramembranous ossification agenesis para axial mesoderm of embryo (sclerotome) myotomes of para axial mesoderm

Q17. Joint and nerve supply, type of joint 1 Ankle 2 Hip 3 4 5 superior tibio-fibular talo-calcaneo-navicular Knee

a b c d e

synovial, plane femoral,obturator,tibial and common peroneal nerve synovial,ball and socket femoral, obturator,sciatic and nerve to quadratus femoris anterior and posterior tibial nerves

Q18. TRUE OR FALSE 1. The triceps muscle is innervated by ulnar nerve. 2. The long head of biceps brachii passes over the upper end of the humerus INSIDE the capsule of the shoulder joint. 3. Initial heat is due to migration of ions. 4. No response occurs on stimulating nerve with constant current. 5. High concentration of calcium ions in ECF increases excitability while low concentration of sodium ions will decrease it.

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Module 5: Musculoskeletal System

2010/2011

Credited to: Questions Maker Unit (QMU) Specially for: Batch 1st Year 2010/2011

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Buona fortuna! / In bocca al lupo! [Spanish] ¡Buena suerte! [Greek] Καλή τύχη! (kalí tíhi!) [Germany] Viel Glück! Alles Gute! [French] Bonne chance ! [Dutch] Succes! Veel geluk! [Russian]Удачи! (Udači) [Scottish] Guid Luck!

Questions maker unit (qmu)

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