qmu module 5 questions & answers

7/31/2019 QMU Module 5 Questions & Answers

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QUESTIONS MAKER UNIT (QMU)

2010/2011

Module 5:

Musculoskeletal SystemQuestions & Answers


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Questions maker unit (qmu) 2

Module 5: Musculoskeletal System 2010/2011

CARTILAGE & BONE

1. All the following are functions of cartilage EXCEPTa. firm and flexible ECM allows cartilage to bear mechanical stress without permanent

distortion

b. its smooth-surfaced provides sliding surface for articulation inside joint cavitiesc. cartilage form epiphyseal plates that play an important role in the growth of flat boned. 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 anysynovial joints?

a. to content the synovial fluid which serves as synovial fluid reservoirb. 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 stressesd. to absorb nutrients and gases from synovial fluid

3. All the following are effect of absence of collagen EXCEPTa. loss of cell-cell communicationb. cell migration as in metastasisc. loss of cell shaped. limitation to cell locomotion

4. All the following are functions of bone EXCEPTa. bone has an important metabolic function by acting as minerals reservoirb. protection of the external vital organsc. gives attachment to different body muscles helping in locomotiond. support and maintenance of body stature

5. All of the following events occur in zone of ossification in endochondral ossification EXCEPTa. vascular mesenchymal bud arise from cellular layer of periosteum to invade ossifyingzone

b. macrophages differentiated into active osteoclast which phagocytose the calcifiedcartilage 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 bonymatrix and promote its calcification

d. release of alkaline phosphatase causing calcification of cartilage matrix


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Module 5: Musculoskeletal System 2010/2011PERIPHERAL NERVES

6. The correct statement about neuron isa. Pseudo-unipolar neuron presents in vestibular gangliab. Polygonal neuron presents in spiral gangliac. Granule cell presents mainly in cerebral cortexd. Pyriform neuron presents in the retina

7. All the following are correct statements concerning potassium ion EXCEPTa. 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 surfaced. 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 area.

Nervous tissue

b. Muscular tissuec. Connective tissued. A and Be. B and C

9. The membrane is absolutely impermeable toa. Cl-b. Proteinsc. HCO3d. HPO4

10.All of the following have ectodermal origin EXCEPTa. Astrocytesb. Microgliac. Oligodendrogliad. Ependymal cells

11.Nerve block includes;a. Failure if conduction of nerve impulseb. Loss of excitabilityc. No generation or propagation of nerve impulsesd. 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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Module 5: Musculoskeletal System 2010/201113.Concerning the sarcoplasmic reticulum in skeletal muscle, the following are correct EXCEPT:

a. The primary role is to control interaction between actin and myosinb. The sarcotubules contain ATPase enzymec. The terminal cisternae contain calsequestrin proteind. 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 issplitted>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 issplitted>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 issplitted>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 couplingb. Occur when the muscle does not respond to a stimulus of the same degreec. Temporary decrease in the work capacity of the nerve of the skeletal muscled. 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 occurb. Creatine phosphate is the major energy reserve

c. Prolonged fasting can cause loss of muscled. 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 myoblastb. The first stage consist of spindle-shaped cells and myofibrilsc. The second stage consist of multinucleated myotubesd. 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 500m long in pregnant uterusb. They are only regulated by the nervous systemc. Thick myofilaments in routine E.M are seen in between thin filamentsd. 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 filamentsb. Calmodulin leads to activation of myosin kinase, thus muscle contractionc. Phosphatase enzyme split the phosphate that leads to muscle relaxationd. Increase of calcium increase excitability of muscle


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Module 5: Musculoskeletal System 2010/201120.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 potentialb. The smooth muscle fibers are capable of slow wave potentialc. The smooth muscle fibers are capable as a pacemakerd. 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 poliomyelitisb. Posterior horn cell releases pathological discharge muscle fasciculationsc. Hypersensitivity to acetylcholine could cause muscle fibrillationsd. Produces long chronaxie in the aspect of its electrical response

22.Regarding the z-line it isa. 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 isa. 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 actind. troponinT-tropomyocin complex covers the actin active sites

25.Sarcomere is,a. distance between 2 -z lines

b. distance between two successivezlines

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 troponinC

d. both ( b ) and ( c ) are correct

27.Muscle proteins responsible for its relaxation involvea. myocin

b. actin

c. tropomyocin

d. troponinC


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Module 5: Musculoskeletal System 2010/201128.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 isa. 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 isa. Tetanic contraction

b. incomplete tetanic contraction

c. Separate contractions


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 isa. No work is done

b. Muscle tension is normal

c. Muscle length is constantd. Both ( a ) and (c ) are correct

33.Warming of the skeletal muscle is associated witha. 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 ita. becomes more streched during relaxation

b. showes stronger contraction

c. sluggish contraction occurs

d. Both ( a ) and ( b ) are correct


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Module 5: Musculoskeletal System 2010/201136. 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 isa. 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 isa. 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 bya. warming

b. cooling

c. fatigued. Both ( b ) and ( c ) are correct

41.Muscle atrophy my occur due toa. 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


43.Which of the following has the potential amplitudea. ventricular muscle

b. visceral plain muscle

c. skeletal muscle

d. nerve cell


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Module 5: Musculoskeletal System 2010/201144.All of the following obey all or none rule EXCEPT

a. Single nerve fibreb. Single skeletal muscle fibrec. Motor unitd. Single smooth muscle fibre with no gap junctions

UPPER LIMB

45.What is the first bone to ossificate?a. Humerusb. Phalangesc. Radiusd. Clavicle

46.Regarding clavicle, the following are correct EXCEPT:a. The rough area laterally is for the attachment of coracoclavicular ligamentb.

The lateral third is flattened form above downward and curves backwards

c. The conoid tubercle is on the smooth surface of the clavicled. 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 passesb. The lateral border ends by the supraglenoid tuberclec. The inferior angle lies opposite to the 7th ribd. The angle that lies on the 2nd rib is almost a right angle

48.Concerning the humerus, the following are true EXCEPT:a.

The groove on the posterior aspect lodges the radial nerve and the profunda brachiivessel

b. The groove on the posterior aspect of medial epicondyle carries the ulnar nervec. The brahioradialis takes origin from the length of lateral supracondylar ridged. Axillary nerve passes around the surgical neck of the humerus

49.These are the nerve supply of the shoulder joint EXCEPT:a. Axillaryb. Pectoralc. Musculocutaneousd. Suprascapular

50.The following are true of the axillary artery EXCEPT:a. Axillary vein is located medially to it at its 1st partb. If it is ligated proximal to the humeral branch, the blood flow can be re-establishedc. A deltoid branch in thoracoacromial artery of the axillary artery shares in an anastomosisd. 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 thumbb. Superficial palmar arch are completed by radial arteryc. Deep palmar arch lies 3cm proximal to the superficial palmar archd. Palmar metacarpal arteries join in the arterial supply of the hand


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Module 5: Musculoskeletal System 2010/201152.These arteries will establish the circulation if there is ligation of brachial artery EXCEPT:

a. Posterior ulnar collateral arteryb. Ulnar arteryc. Radial arteryd. Interosseous recurrent artery

53.The course and relations of brachial artery are the following EXCEPT:a. Accompanied by two venae commitantsb. Relatively superficial 3/4th of its coursec. Related medially to the basilic veind. 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 arteryb. Medial pectoral nerve at the medial aspect of the 2nd part of the arteryc. Both of the pectoralis muscle at the anterior of the 2nd part of the arteryd.

Pectoralis major muscle are at the anterior of the 3

rd

part of the artery

55.The quadrangular space is bounded by all of the following EXCEPT:a. Teres minorb. Teres majorc. Long head of bicepsd. Long head of tricepse. Surgical neck of the humerus

56.Regarding the biceps brachii, one is INCORRECT:a. Has long head attached to the supraglenoid tubercleb.

Has short head attached to the tip of the coracoid processc. Has a tendon inserted into the radial tuberosity

d. It flexes the elbow jointe. It is powerful supinator of the extended elbow

57.The nerve supply of the pectoralis major is by _________ nerve/sa. 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 herright 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 nerveb. Median nervec. Ulnar nerved. Radial nerve


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Module 5: Musculoskeletal System 2010/201159.The lesser tuberosity of the humerus give attachment to:

a. Teres minorb. Teres majorc. Supraspinatusd. Infraspinatuse. Subscapularis

60.The following tendon cross the carpal tunnel EXCEPTa. Flexor carpi ulnarisb. Flexor digitorum superficialisc. Flexor digitorum profundusd. Flexor pollicis longus

61.The following structure pass deep to the extensor retinaculum EXCEPTa. Abductor pollicis longusb. Extensor pollicis brevisc.

Brachioradialis

d. Anterior interosseous arterye. Posterior interosseous nerve

62.Which muscle will compensate in part for the paralysis of supinator muscle?a. Extensor carpi ulnarisb. Anconeusc. Biceps brachiid. Brachialis

63.During its course in the upper limb, the median nerve lies:a.

In front of lateral epicondyle of humerusb. Medial to brachial artery in cubital fossa

c. Against spiral groove of humerusd. Against surgical neck of humeruse. Superficial to flexor retinaculumf. Behind medial epicondyle of humerus

64.The only muscle of upper limb that has pelvic origin isa. Serratus anteriorb. Pectoralis majorc. Subscapularisd. Latissimus dorsie. Teres major

65.Anastomosis around the scapula connects subclavian artery with:a. First part of axillary arteryb. Second part of axillary arteryc. Third part of axillary arteryd. Brachial artery


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Module 5: Musculoskeletal System 2010/201166.Rotator cuff muscles are composed of the following EXCEPT

a. Teres majorb. Teres minorc. Supraspinatusd. Subscapularise. Infraspinatus

67.Concerning long thoracic nerve, all are correct EXCEPTa. Supplies serratus anterior muscleb. Branch of posterior cord of brachial plexusc. Its root value is C5, 6, 7d. Cutaneous to the lateral wall of thoraxe. 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

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 excepta. 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 excepta. femoral nerve

b. femoral vein

c. femoral artery

d. lymph nodes


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Module 5: Musculoskeletal System 2010/201173.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 musclesd. 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 ofa. anterior division of the internal iliac artery

b. posterior division of the external iliac arteryc. posterior division of the internal iliac artery

d. anterior division of femoral artery

78.All are true excepta. 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 excepta. 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 excepta. 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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Module 5: Musculoskeletal System 2010/201181.All the following are correct regarding the relations of femoral arteries EXCEPT

a. Lateral femoral nerveb. Posterior psaos major, pectineus, adductor magnus and posterior wall of rectus sheathc. Medial inguinal lymph nodes groupd. Anterior - skin, superficial fascia, deep fascia,& anterior wall of femoral sheath

82.Great saphenous vein receives all of the following veins before entering into saphenousopening EXCEPT

a. Epigastric veinb. Popliteal veinc. Pudendal veind. Superficial circumflex iliac vein

83.All of the following are branches of profunda femoris artery which share in someanastomosis in lower limb EXCEPT

a. Tranverse branch of lateral circumflex femoral arteryb.

Descending branch of lateral circumflex femoral artery

c. Acetabular branch of medial circumflex femoral arteryd. Ascending branch of medial circumflex femoral arterye. 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 arteryb. 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 tibialartery

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 varicosevein?

a. Weak valves congested the veinb. Chemical mediator reactionsc. Decrease oxygen concentration in venoule bloodd. Gravitational pull

86.All the following are branches of dorsalis pedis artery, EXCEPTa. First plantar metatarsal arteryb. First dorsal metatasrsal arteryc. Arcuate arteryd. Plantar metatarsal arteries

87.All the following are the correct match of artery and its continuation artery after terminationEXCEPT

a. Peroneal artery calcanean arteryb. Posterior tibial artery medial and lateral plantar arteriesc. Anterior tibial artery arcuate arteryd. Popliteal artery anterior and posterior tibial artery


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Module 5: Musculoskeletal System 2010/201188.All the following flexors of thigh joint are supplied by femoral nerve EXCEPT

a. Psaos majorb. Illiacusc. Rectus femorisd. Sartorius

89.All the following are muscles originate from area between pubic tubercle and ischialtuberosity EXCEPT

a. Gracilisb. Adductor longusc. Adductor brevisd. 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 positionb.

Important during walking

c. Maintain shape of the thighd. Allow flexion of knee joint

91.Which of the following muscle passes through Greater Sciatic Foramen?a. Obturator internusb. Gemellus inferiorc. Piriformisd. Quadratus femorise. Gemellus superior

92.Above is an ischial tuberosity diagram with its compartment. Which of the following iswrong?

a. Semimembranosusb. Semitendinosus & Biceps Femoris (short head)c. Subcutaneousd. Adductor Magnus (Ischial part)

b.

a.

c. d.


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Module 5: Musculoskeletal System 2010/2011VERTEBRAE

93.All are true about vertebrae column excepta. 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 maled. C1 is known as atlas

94.All true typical vertebrae and ossification excepta. 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. clavicleb. 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 excepta. 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. C 26. D 51. A 76. D2. B 27. C 52. A 77. C3. D 28. D 53. B 78. C4. B 29. D 54. D 79. A5. d 30. A 55. C 80. D6. D 31. B 56. E 81. B7. D 32. D 57. C 82. B8. D 33. D 58. B 83. C9. B 34. D 59. E 84. D10. B 35. D 60. A 85. A11. D 36. B 61. C 86. D12.

A 37.

D 62.

C 87.

C13. D 38. C 63. B 88. A

14. C 39. B 64. D 89. E15. C 40. D 65. C 90. A16. D 41. D 66. A 91. C17. B 42. D 67. B 92. B18. C 43. D 68. C 93. A19. A 44. D 69. A 94. C20. D 45. D 70. A 95. D21. B 46. B 71. C 96. D22. B 47. D 72. A 97. C23. A 48. C 73. D 98. C24. D 49. B 74. D 99. B25. B 50. B 75. A


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1. Tabulate the differences between the types of cartilage.Cartilage Hyaline Elastic White Fibro

Perichondrium Covered by perichondrium

except inside joint cavities

Always covered by

perichondrium

Never covered by

perichondrium

ECM - Glassy, translucent

- Fibers has same refractive

index with ground substance

- very large number of

interlacing elastic fibers

- demonstrate by orcein

and V.V.G. stains

Contains thick bundles of

type I collagen fibers running

in different directions but

sometimes parallel and

separated by narrow bands

of non-fibrous matrix

Types of fibers Mainly type II collagen and

few elastic fibers

Abundant elastic fibers +

type II collagen

Abundant type I collagen +

few type II

Chondrocytes - present inside lacunae

surrounded by capsule

- at periphery, young

chondrocytes are present

underneath perichondrium

- chondrocytes are scattered

- Chondrocytes are

numerous

- rounded chondrocytes lie in

rows in narrow bands of

non-fibrous matrix

Number of

chondrocytes/

capsule

1-8 1-3 1-2

Sites 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

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

Significance - Firm but flexibles

- Present of cell nest

- 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 bonestructure and shape throughout life.


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Module 5: Musculoskeletal System 2010/20113. Describe the biochemical composition of cartilage and synovial fluid (GAG):

i. Collagenii. Proteoglycansiii. Glycoproteini. CollagenCollagen 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 H-

bonding between chains. While the hydroxyl groups of hydroxylysine are partly glycosylated

with a disaccharide (GlcGal) and help linking tropocollagen molecules together

ii. ProteoglycansThese 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. GlycoproteinGlycoproteins 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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Module 5: Musculoskeletal System 2010/20115. Compare between compact bone and cancellous bone.

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 DendriteSingle process Single or multiple processes

Cylindrical Tapering to one end

Not branched except at its termination or

collaterals

Has many branches

Originate from axon hillock Originate from any part of perikaryon

May be covered by sheaths No sheaths

Does not contain Nissls granules Contain Nissls granules

Centrifugal impulse Centripetal impulse transmission


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Module 5: Musculoskeletal System 2010/20118. 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 volume9. 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 DecreasedCoincides with After depolarization After hyperpolarization


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Module 5: Musculoskeletal System 2010/201113.Compare between the uses of energy during rest and during activity.Comparison [pg 73]

During rest During activity

- Maintain polarizaed state of themembrane

- Maintain ionic composition across cellmembrane

- Na/K pump mechanism derives energyfrom breakdown of ATP

Energy expenditure is doubled to restore

polarized state of the membrane.

Oxygen consumption is increased.

14.Give a short account ona) Myelinated nerve fibres in CNSb) Unmyelinates nerve fibres in PNS

Ans: (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 it2. They maintain the body posture by their tonic contraction and muscle tone3. 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- Numerous blood capillaries- Increasing number of mitochondria

- Absence of myoglobin- Few blood capillaries- Few mitochondria- Extensive reticulum- Large amounts of glycolytic enzymes

- Longer latent period- Contract slowly- Fatigue slowly

- Short latent period- Contract rapidly- Fatigue easily

Maintain body posture against gravity Better at generating burst of speed and force

Eg: back muscle and soleus muscle in marathons

and bicycle for hours

Eg: A sprinter

(pg.92-93)


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Module 5: Musculoskeletal System 2010/201118.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 functiono 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 ofnerve 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 Isometric contraction

Light/moderate Load Heavy

Muscle shorten Length of contraction Muscle does not shorten

Load moves Movement of load Load does not move

There is work done Work No work done

75% Conversion to heat 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 inaerobic conditions only.

3. Oxidative phosphorylation: greatest source of ATP in aerobic conditions


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Module 5: Musculoskeletal System 2010/20114. Creatine phosphate: creatine + ATP ADP + creatine phosphate. Creatine phosphate is a

major energy reserve which is a reversible reaction.

5. Adenylyl kinase : myosin ATPaseATP 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

vessels

Site Muscle lining the b.v., ciliary muscle, iris

of eye, piloerector muscle

In the form of bundles and presence of

gap junctions

Characteristics Made of separate fibers

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 Striated non-striated

Movement Voluntary Involuntary

Site 1. attached to skeleton

2. ocular muscle

3. muscle of face, tongue,

pharynx, diaphragm & upper

2/3 of oesophagus

Visceral smooth muscle:

1. digestive tract2. urinary tract3. genital tract4. many blood vessels

Multi-units smooth muscle:

1. muscle lining blood vessels2. ciliary muscle & iris of eye3. piloerector muscle of hair

Stimulus/i nerve impulse 1. nerve impulse

2. hormone (non-nervous)

3. cytokine (non-nervous)

Innervations central nervous system autonomic nervous system

LM: Shape long, cylindrical cell (fiber) elongated, fusiform (spindle) cell

LM: Nucleus multinucleated, pale, elongated

oval, periphery

single, pale, oval, central

LM: Sacroplasm Scanty, eosinophil; filled with abundant, homogenous eosinophil


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Module 5: Musculoskeletal System 2010/2011numerous longitudinally

oriented myofibrils

Myofibrils Thick & thin myofilaments Thick & thin myofilaments

Proportion of actin:

myosin

Lesser than skeletal muscle Greater than skeletal muscle

Arrangement ofmyofibrils

Fibers are parallel to each otherwith the same registration of

light and dark bands of adjacent

fibers

Group in bundles with irregularorientation, more or less oblique to

long axis of the cell

Troponin Present (part of thin filament) Lack of troponin

Attachment of thin

filaments

Z-lines (presence of alpha-

actinin)

Dense bodies (presence of alpha-

actinin)

Presence of desmin Absent Present

Basal lamina covering

sacrolemma

Present Present

Sacroplasmic reticulum Well developed Not well developedCentrioles Absent Present

Gap junction Absent May present

Sacromere Regular Absent

Triad of tubular system Present Absent

T-tubules Present small at junction

between A and I bands

Absent- caveolae instead

Contraction-Relaxation Faster Slower

Energy needed High Small (only 1 ATP)

Troponin-C Present Absent calmodulin instead

Enzymes involved ATPase enzyme ATPase enzyme

Myosin kinase

Phosphatase

Source of calcium Terminal cisternae of

sarcoplasmic reticulum

Mainly extracellular fluid, in addition

of sarcoplasmic reticulum in some

smooth muscle

Calcium pump Faster Slower

Period of contraction Short Long

Action potential Spike potential Spike potential & action potential

with plateau

RMP -90mV -50Mv

Duration of spike

potential

1-5 msec 10-50 msec

Magnitude of action

potential

130 mV

Rythmic contraction Absent Present

Tonic contraction Present Present

Excitability More excitable Less excitable

Chronaxie Short Long

Force of muscle

contraction

Lesser than smooth muscle Greater than skeletal muscle

Cycling of the Myosin

Cross-Bridges

Faster Slower


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Module 5: Musculoskeletal System 2010/2011P/S: Dont 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 Nerve Fiber

RMP -90mV -70mV

Magnitude 130 mV 105mV

Duration of action potential 1-5 msec

Velocity of excitation wave

conduction

3-5 m/sec up to 120 m/sec (in thick

myelinated nerve fibers)

Duration of after potential Longer 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 myofibrilsover the thick filament.

- During rest, troponin T tropomyosin complex covers the binding sites for myosin heads onactin filaments, inhibit contraction.

- Binding of Ca2+ to Troponin C causes uncover of myosin binding sites as tropomyosin moveslaterally.

- 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 andH-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 ofaction potential, which spreads along both sides of the sarcolemma membrane.

- The action potential spreads to the depth of the myofibrils via T-tubular system (extendingfrom sarcolemma membrane).


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Module 5: Musculoskeletal System 2010/2011- 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 thebinding 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 betweenmyosin 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 astropomyosin 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 Muscular factor

The labrum glenoidalethat deepens the

shallow glenoid cavity.

Coraco-acromial archthat prevents the

upward dislocation of

the head of humerus.

Labrum glenoidale Coraco-acromial

ligamentas bridges

over bony arch.

Rotator cuff muscles(SITS) adhere to capsule

of joint.

Splinting effectoftriceps and biceps

muscles.

Long head of bicepsprevents upward

dislocation.

(pg. 195)

31.Tabulate the differences between the small joints of the hand:Intercarpal

joints

Carpometacarpa

l joints

Intermetacarpa

l joints

Metacarpophalangea

l joints

Interphalangea

l joints

Typ

e

Synovial Plane, synovial

EXCEPT 1st

carpometacarpal

(saddle, biaxial,synovial)

Plane, synovial Ellipsoid, biaxial,

synovial

Hinge

Site Between

carpal

bones

(proximal

and distal

form S-

shape

transverse

intercarpals

)

Distal row of

carpal bones and

metacarpal

bones

Between

adjacent parts

of the bases of

the medial 4

fingers

Between metacarpal

bones and the

proximal phalanges

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

brachial a. opposite the neck of radius

Beginning As one of the two terminal branches of

brachial a. opposite the neck of radius

Smaller Size Larger

o Descends in the forearmo Passes anterior of radiuso Lies superficial at wristo Reaches the anatomical snuff

box where it lies on scaphoid

bone

o Enters between two heads ofthe first dorsal interosseous

muscle

o Continues in the hand as depppalmar arch

Course o Descends in the forearmo Lies superficial to the flexor

retinaculum

o Enters the hand and continuesas superficial palmar arch

o Radial recurrento Muscular brancheso Nutrient artery to radiuso Ant and post carpalo Superficial palmar brancho Forst dorsal metacarpal branch

Branches o Anterior and posterior ulnarrecurrent

o Common interooseouso Nutrient artery to ulnao Carpal branches

(pg. 173-174)

33.Give a short account of the anastomosis around the surgical neck of humerus:

1. 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 artery2. If axillary artery is ligated distal tohumeral and subscapular branches, blood flow can be re-

established by these branches and profunda brachii.

3. If axillary artery is ligated distal to profunda brachii and sup ulnar collaterall arteries, bloodflow can be re-established by: - Inferior ulnar collateral - Ulnar artery

- Radial artery - Interosseous recurrentartery

(pg. 157)

34.Give a short account of the veins of the upper limb:Superficial venous system Deep venous drainage

Palmar and dorsal digital veins onrespective surfaces of the digits:

- join to form dorsal metacarpal veins that

anostomose to form dorsal venous arch

Cephalic vein: lateralcontinuation of dorsalvenous arch:

- ascends along radial side of forearm to

Deep venousarcades in the hand 2 veins accompanying an artery(venae

comitantes) of radial, ulnar and brachial

arteries

The venae comitantes of radial and ulnararteries join to form the vena comitantesof the brachial artery, which unite the


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Module 5: Musculoskeletal System 2010/2011cubital fossa

- passes in deltopectoral groove

- terminate by piercing clavipectoral fascia

and drain into axillary vein

Basilic vein: medialcontinuation of dorsalvenous arch:- ascends along ulnar side of the forearm

- pierces deep fascia in arm and unites with

brachial vein to form axillary vein

Median cubitalvein in cubital fossa:- passes oblique across fossa to connect

cephalic and basilica vein.

- used for IV injections

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.Enumerate structures that passing superficial to flexor retinaculum.37.Give an account on arterial anastomosis around the elbow joint.38.What are the causes of winging scapula?39.Fill in the blanks with suitable wordsi) Two examples of the synovial ball and socket joints

a) _____________________b) _____________________

ii) Deep palmar arch is formed mainly by _______________while superficial palmar arch isformed mainly by _________________.

iii) Axillary artery is a continuation of _______________artery at ___________border of_______________rib.

iv) The ______________________muscle divides the axillary artery into three parts.v) Two structures that pass around the surgical neck of humerus are

a) ______________________b) ______________________


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Module 5: Musculoskeletal System 2010/2011Answers (for Q 35 - 39)

35.1) Median nerve2) 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 longus37.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 superiorulnar 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) whichlead to paralysis of serratus anterior muscle.

39.Fill in the blank.i) Shoulder joint, hip jointii) Radial artery, ulnar arteryiii) Subclavian, outer, firstiv) Pectoralis minorv) Axillary nerve, posterior circumflex humeral artery40.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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Module 5: Musculoskeletal System 2010/2011Law 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 HallucisLongus).

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 .Itterminates 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 andits 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 ofquadriceps 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 twoactions for each muscle.

Tibialis posteriorinversion, 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 courseand 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 thatprevent hyperextension.

Medial semilunar cartilage, lateral semilunar cartilage, anterior cruciate ligament, posterior

cruciate ligament and popliteus tendon.


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Module 5: Musculoskeletal System 2010/201151.State the course and relations of the posterior tibial nerve.52.Explain one example of bone that maintains the joint stability.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 Skeleton of embryo

B Elastic cartilage Auricle of ear

C White fibrocartilage 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 NERVE TISSUE SITE

A Bipolar 1 Olfactory mucosa of the nose

B Stellate 2 Cerebral cortex

C Pseudounipolar 3 Spinal ganglia

D Pyramidal 4 Sympathetic ganglia

E Pyriform 5 Common in invertebrates

F Golgi type I 6 Brain and spinal cord

G Golgy type II 7 Purkinje cell layer

H Unipolar 8

Q3.

Epimysium a. Thin fibrous septaPerimysium b. Dense connective tissueEndomysium c. Delicate connective tissue sheets


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Module 5: Musculoskeletal System 2010/2011Q4. MUSCLE NERVE SUPPLY

A Teres major 1 Suprascapular nerve

B Pectoralis minor 2 Radial nerve

C Supraspinatus 3 Lower subscapular nerve

D Deltoid 4 Long thoracic nerve

E Subscapularis 5 Axillary nerve

F Rhomboideus major 6 Dorsal scapular nerve

G Teres minor 7 Medial pectoral nerve

H Serratus anterior 8 Thoracodorsal nerve

Q5. MUSCLE NERVE SUPPLY

A Flexor carpi ulnaris 1 Median nerve

B Pronator teres 2 Radial nerve

C Flexor digitorum profundus 3 Musculocutaneous nerve

D Brachioradialis 4 Ulnar nerve

E 3rd

palmar interosseous 5 Deep branch of radial nerve

F Extensor carpi ulnaris 6 Anterior interosseous nerve

G Extensor carpi radialis longus 7 Deep branch of ulnar nerve

H Palmaris brevis 8 Superficial branch of ulnar nerve

Q6. NERVE SUPPLY ROOT VALUE

A Axillary nerve 1 C5

B Median nerve 2 C5, 6

C Radial nerve 3 C5, 6,7

D Ulnar nerve 4 C6, 7, 8

E Thoracodorsal nerve 5 C5, 6, 7, 8

F Dorsal scapular nerve 6 C7, 8, T1

G Musculocutaneous nerve 7 C8, T1

H Long thoracic nerve 8 C5, 6, 7, 8, T1

Q7. DEFORMITY NERVE INJURY

A Ape hand 1 Ulnar nerve

B Weakness of flexion of the arm 2 Radial nerve

C Loss of lateral slop of the neck 3 Musculocutaneous nerve

D Partial claw hand 4 Median nerve

E Wrist drop 5 Upper trunk of brachial plexus

F Finger drop only 6 Lower trunk of brachial plexus

G Erbs paralysis 7 Spinal accessory nerve

H Klumpkes paralysis 8 Posterior interosseous nerve


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Module 5: Musculoskeletal System 2010/2011Q14. 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 A upper part of medial surface of tibia

2 Peroneus longus B third layer of muscles of sole

3 Sartorius,gracilis,semitendinosus insert into C common peroneal part of sciatic nerve

4 adductor hallucis D fourth layer muscles of sole

5 plantar interossei muscles E musculocutaneous nerve

Q16. Development of bones, vertebrae and muscles

1 example of abnormal muscle a kyphosis

2 vertebrae developed from b intramembranous ossification

3 example of abnormal vertebrae c agenesis

4 muscles developed from d para axial mesoderm of embryo

(sclerotome)

5 Clavicle e myotomes of para axial mesoderm

Q17. Joint and nerve supply, type of joint

1 Ankle a synovial, plane

2 Hip b femoral,obturator,tibial and commonperoneal nerve

3 superior tibio-fibular c synovial,ball and socket

4 talo-calcaneo-navicular d femoral, obturator,sciatic and nerve to

quadratus femoris

5 Knee e 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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[Italian]Buona fortuna! / In bocca al lupo![Spanish]Buena suerte!

[Greek]! (kal thi!)[Germany] Viel Glck! Alles Gute!

[French]Bonne chance ![Dutch]Succes! Veel geluk!

[Russian]!(Udai)

[Scottish] Guid Luck!
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