1. Unit 2 Exam Review: Musculoskeletal SYstem
ANATOMY & PHYSIOLOGY 13-14

2. Unit 2 Musculoskeletal Anatomy & Physiology
10 Second Diagnoses
Unit 2 Musculoskeletal Anatomy & Physiology

3. PATIENT A: 23 yr old Asian Male
Patient A has been reporting symptoms of nausea, heartburn and general flu-like muscle/joint pain for several weeks. He shows evidence of periorbital edema (fluid buildup around the eyes). His fingernails have split and are bleeding underneath the nail bed.
Your Diagnosis?
A) Muscular Dystrophy
B) Trichinosis
C) Osteoporosis
D) Macular Degeneration
ANSWER: B (Trichinosis)

4. Patient B: 82 Year old Caucasian Female
Patient B is immediately recognizable for a kyphotic spine (leaning forward) and spinal compression. She has recently been hospitalized for a fractured hip and reports chronic radicular pain (pain radiating out of joints).
Based upon your intial diagnosis of osteoporosis, what test would be most useful in confirming this suspicion?
A) Computer Assisted Tomography (CAT Scan)
B) Positron Emission Tomography (PET Scan)
C) Dual Energy X-Ray Absorptiometry (DEXA Scan)
D) Endscopy
ANSWER: C (DEXA Scan)

5. PATIENT C: 8 Year Old African-American Male
Patient C is showing gradual deterioration of motor skills, with alterations to the patient’s gait and intellectual impairment. These symptoms are also shared with Parkinson’s disease. What substance, essential to the disease state, should be missing in each disease that would allow you to determine if the individual has MD or PD?
ANSWERS:
PD: Lack of Dopamine
MD: Lack of Dystrophin

6. PATIENT D: 45 Year OLD Latino FEMALE
Patient D has recently moved to the United States with minimal prior health care and no medical records available. Patient has reported lifelong problems with fractures and slow-healing skeletal breaks. Patient has blue sclera, brittle teeth and has conductive hearing loss in both ears.
DIAGNOSIS:
A) Osteoporosis
B) FOP (Stone Man Syndrome)
C) Osteogenesis Imperfecta
D) Gorham’s Disease (Phantom Bone Syndrome)
ANSWER: C (OI)

7. Production of blood cells
I can identify the six (6) primary skeletal system functions, and give an example of a skeletal feature that facilitates each function.
#1) _____ Which of the following is NOT a function of the skeletal system?
Movement
Production of blood cells
Regulation of hormones (this is the function of the endocrine/nervous system)
Support

8. I can describe the physiological function of cartilage in the endoskeleton, and I Can provide examples of where one would find hyaline (articular) cartilage in the human body.
#2) What type of cartilage would you expect to find at the pubic symphysis? Why?
Fibrous cartilage; not supposed to ossify. Meant to stretch but not tear.

9. I can describe the physiological function of cartilage in the endoskeleton, and provide examples of where one would find hyaline (articular) cartilage in the human body.
#3) What type of cartilage would you expect to find at the epiphyses of long bones? Why?
HYALINE CARTILAGE; meant to undergo endochondral ossification to allow for interstitial growth of bone

10. I can compare/contrast between cortical and cancellous bone structure and function, as well as provide examples/locations of each in the endoskeleton.
#4) Why is cortical bone necessary in the diaphysis of long bones while cancellous bone is utilized in the epiphysis of long bones and in short (or sesamoid) bones? Describe the structural difference between each type of bone and relate this to the function of each type of tissue.
Cortical bone, being more dense, is used for support in the diaphysis (center length) of bones while cancellous bone, being less dense, is used for shock absorption in the epiphysis/ends of long bones and in sesamoid bones

11. I can describe the physiological function of red and yellow marrows in the endoskeleton
#5) Describe the difference in location and function between red marrow and yellow marrow.
Red Marrow is the site of hematopoiesis (red blood corpuscle production) and is found in the cancellous bone on the epiphysis (ends) of long bones, the sternum and ribs
Yellow Marrow is the site of leukopoiesis (white blood cell production) and is found embedded in the cortical bone of the diaphysis of long bones

12. I can explain the role of the periosteum in the skeletal system, and can describe various injuries to this structure such as bone bruises and periostitis (shin splints).
#6) A student plays a fall sport that involves a lot of running. Their lower legs start to hurt, so they go see the trainer in the PERC. The trainer tells them they have “shin splints”. Describe what the structure this condition affects, what it does to that structure, and how to prevent/treat the condition.
Irritation at points of insertion and origin where tibia anterior frontalis connects to periosteum of lower leg. Icing, anti- inflammatory drugs and arch supports.

13. I can distinguish between the various bone shapes (long, short, sesamoid, flat, or irregular) and give examples of each bone shape within the human skeleton.
long
flat
flat
irregular
Short/sesamoid

14. I can distinguish between the various bone shapes (long, short, sesamoid, flat, or irregular) and give examples of each bone shape within the human skeleton.

15. I can describe the following processes that occur in the skeletal system, and the role of hormones, osteoblasts, and/or osteoclasts in each process.   Bone formation (ossification)   Bone growth, at epiphyseal plates (length) and diaphysis (width)
#9) Why is it important for young children to wear wrist guards when roller blading? Explain in terms of epiphyseal plates, endochondral ossification and interstitial growth.
Injuring the radio-ulnar joint with the carpal bones can result in permanent damage to the epiphyseal (growth) plates at the distal end of the long bones in the lower arm. Without the activity of the chondrocytes in this tissue, the cartilage in the epiphyseal plates will not undergo endochondral ossification. This is turn, would severely limit any interstitial growth of the long bones of the lower arm.

16. I can describe the following processes that occur in the skeletal system, and the role of hormones, osteoblasts, and/or osteoclasts in each process.   Bone formation (ossification)   Bone growth, at epiphyseal plates (length) and diaphysis (width)   Bone remodeling (in response to seral calcium levels and bone stress/force of gravity)   I can predict the effect of high seral calcium levels or bone stress and the effect of low seral calcium levels or bone stress, and how this can lead to osteoporosis or bone wasting (atrophy).
#10) One of the difficulties in planning for a prolonged space flight (i.e. a mission to Mars) concerns the preservation of the astronauts’ muscloskeletal anatomy. Based upon your knowledge of osteoclasts, osteoblasts and bone remodeling, explain why extended space flight in zero- or micro-gravity would be problematic in terms of skeletal integrity.
Without regular stressing of the appendicular skeleton by skeletal muscle, osteoclast activity will outweigh osteoblast activity, effectively causing the bone tissue to waste away as it is recycled.

17. I can discern between the types of synovial joints in the appendicular skeleton (fixed, ball & socket, hinge, pivot, saddle, gliding, condyloid), and can describe the range or type of motion for each type of joint. I can identify examples of explain the functional difference between bones of the axial skeleton as compared with those of the appendicular skeleton.

18. A = Cardiac B = Skeletal C = Visceral B #14) Gastrocnemius (calf)
I can discern between the histological and functional differences between the three types of muscle: visceral, smooth and cardiac
#13-18) Match the anatomical structure with its correct histological muscle type
A = Cardiac B = Skeletal C = Visceral
B #14) Gastrocnemius (calf)
C #15) Jejunum (2nd/middle section of small intestine)
C #16) Esophagus (throat)
B #17) Masseter (muscle attached to mandible)
A #18) Ventricular septum (heart)

19. I can compare/contrast between cortical and cancellous bone structure and function, as well as provide examples of each in the human skeletal system.   I can describe the physiological function of red and yellow marrows in the endoskeleton
#6-10) From memory, draw a cross section of bone in the space below labelling the following five structures

20. I can identify the six (6) primary skeletal system functions, and give an example of a skeletal feature that facilitates this function I can describe the physiological function of red and yellow marrows in the endoskeleton. I can discern between points of origin and insertion in terms of a skeletal muscle.
#11-13) How does the anatomy of the circulatory, muscular and skeletal systems illustrate the concept of the physiological interdependence of systems? In other words, how do the structures of these three system connect (literally and figuratively) to the function of the other systems? Give specific examples in your answer based upon observations made in lab.
A) Red and yellow marrows in center of cancellous/cortical bone used for hematopoiesis
B) Haversian canals innervate osteon, delivering oxygen and food to osteocytes
C) Muscular contraction relies upon tendons attached to tuberosities on bone
D) Muscular contraction requires calcium ions that are stored in intercellular matrix

21. I can explain the functional difference between bones of the axial skeleton as compared with those of the appendicular skeleton.   I can distinguish between fibrous joints, cartilaginous joints, and synovial joints.   I can discern between the types of synovial joints in the appendicular skeleton (fixed, ball & socket, hinge, pivot, saddle, gliding, condyloid), and can describe the range or type of motion for each type of joint.
#19-23) True/False T = True F = False If the statement is false, correct it.
F #19) The cranial sutures, pubic symphysis and temporomandibular joints are all examples of fixed joints
T #20) The humeral-scapular joint allows for adduction/abduction while the humeral-ulnar joint allows for flexion/extension
T #21) The sternum, cranium and sacrum are all examples of axial skeletal structures
F #22) Myocardiocytes (i.e. cardiac muscle cells) are intercalated, unlike visceral and skeletal muscle tissues, as the cells of the heart need to contract in synchrony with each other.
F #23) The sarcoplasmic reticulum is essential to the function of skeletal myocytes as it releases calcium ions which, in turn, allows for the myofilaments to slide across each other

22. I can discern between the anatomical forms of tendons v
I can discern between the anatomical forms of tendons v. ligaments and can connect each’s form to its specific function in regard to the appendicular skeleton.
#24) Contrast ligaments & tendons in terms of their anatomical form & physiological function.
Ligaments: connect bone to bone, keep joint in alignment, flexible/elastic
Tendons: connect muscle to bone at points of origin and insertion, allow muscle to exert force on bone, tough/inelastic

23. #25) Analogous Structures
I can classify the biceps & triceps, and the radialis & ulnaris muscles as antagonistic muscle pairs, and describe their muscular physiology
#25) Analogous Structures
Extensor carpi radialis is to flexor carpi ulnaris as triceps brachii is to biceps brachii

24. I can describe the critical role of the motor unit, neuromuscular junction, and acetylcholine (ACh) in the physiology of muscle contraction.   I can explain the role of calcium and the sarcoplasmic reticulum in the physiology of muscle contraction, and the role of the parathyroid hormone in providing additional calcium from the skeletal system.   I can articulate the steps and relative positions of actin and myosin myofilaments in the sliding filament theory.
#26) List the “steps” involved in muscle contraction, starting with a motor neuron and ending with the sliding filament theory (be specific). What are the key players at each step?
Motor neuron (efferent neuron) delivers action potential to synapse with sarcolemma of myocyte (muscle fiber)
Acetylcholine crosses synapse, triggering release of calcium from sarcoplasmic reticulum inside of myocyte
Using ATP and Calcium, the myofilament myosin attaches to the actin myofilament, driving it forward. This causes the sarcomere to shorten/contract
When action potential ends, calcium is reabsorbed by the sarcoplasmic reticulum and the myofilaments slide back to their original positions

25. Long endurance activities require slow twitch muscle fibers
I can discern between the key features of aerobic v. anaerobic respiration in terms of energy production and muscle fatigue.   I can discern between the features of slow v. fast twitch muscle, citing differences in energy production that lead to differences in muscle fatigue.   I can distinguish the key features of aerobic, anaerobic and isometric exercise.
27) Observe the graph of muscle force v. time. If the force of contraction is not significantly different between fast and slow twitch muscle fibers, then why do some athletic events like shot put and sprinting tend to utilize fast twitch (type 2) muscle fibers while others, such as water polo and ultra- marathon require greater utilization of slow twitch (type 1) muscle fibers? Explain how the nature of these different activities match the physiological differences between fast and slow twitch skeletal muscle.
Long endurance activities require slow twitch muscle fibers
as they do not supply as much force as fast twitch
but do not tire as easily. Type 1 muscle fibers are primarily
aerobic, yielding more energy over more time (less power)
while type 2 muscle fibers utilize phosphagen or lactic acid pathways

26. I can discern between the key features of the three ATP metabolic pathways (phosphagen system, lactic acid fermentation, and aerobic cellular respiration) in terms of energy production, muscle fatigue, energy source, and types of exercise that utilize each pathway.   I can discern between the physiological features of slow (type I) v. fast (type II) twitch muscle fibers, explaining how each’s mode of cellular respiration determines each’s time to muscle fatigue.
A student wants to bulk up to make weight for a heavy-weight wrestling category. What is the best type of exercise (aerobic, anaerobic, isometric) to accomplish this goal? Explain what this type of exercise does to the anatomy (and therefore physiology) of the musculature of the individual.
ISOMETRIC EXERCISE. As muscles are pitted against immovable objects, maximal force must be exerted. This results in “bulking up” due to an increase in muscle fiber SIZE (because more contractile fibers are produced). Also increases the amount of connective tissue that reinforces the muscle

27. I can explain the role of calcium and the sarcoplasmic reticulum in the physiology of muscle contraction.
#29) Hypocalcemia is a condition noted by low seral calcium levels. The cause of hypocalcemia can range from insufficient Vitamin D to lack of exposure to sunlight. Symptoms of hypocalcemia include a higher tendency to suffer broken bones, uncontrolled muscle cramping and impaired reasoning abilities. How do these three symptoms illustrate the multifaceted role of calcium in the physiology of the nervous and musculoskeletal systems? Be explicit in terms of how calcium is utilized by each system.
A lack of calcium would affect nervous and musculoskeletal physiology as neurotransmitters could not be released across the synapse, bones would lose their density (osteoporosis) and actin/myosin myofilaments would not be able to slide across each other properly

28. I can apply all lab/activity concepts, skills, and results from this unit as specific support of the targets listed below. I can integrate two or more targets together into one cohesive idea or explanation.
#30) How does the anatomy of the muscular and skeletal systems illustrate the concept of the physiological interdependence of systems? In other words, how do the structures of these two systems connect (literally and figuratively) to the function of the other system? Give specific examples in your answer based upon observations made in lab.
Without the attachment points of the skeleton (origin & insertion), muscle could not provide movement.
Muscular contraction frequently relies on the actions of the osteoclasts to provide calcium for muscle contraction when seral calcium levels are low

29. I can explain the role of the periosteum in the skeletal system, and distinguish between a bone bruise and periostitis (shin splints). I can organize gross muscle anatomy from most complex (largest, most inclusive) to simple (smallest/least inclusive) including muscle body, fascicles, myofibers, myofibrils, sarcomeres, and myofilaments
#31-32) The suffix “-itis” means “inflammation”. This suffix may be appended to any structure that has become swollen or inflamed (i.e. meningitis, peritonitis, gastroenteritis, etc). What, then, is the physiological difference between plantar fasciitis and periostitis? Hint: The former afflicts the muscular system while the latter afflicts the skeletal system.
Plantar fasciitis is inflammation of the fascia covering the flexor digitorum brevis muscle between the calcaneous (heel) and tarsal bones of the foot.
Periostitis is inflammation of the periosteum surrounding the tibia bone of the lower leg.

30. I can organize gross muscle anatomy from most complex (largest, most inclusive) to simple (smallest/least inclusive) including muscle body, fascicles, myofibers, myofibrils, sarcomeres, and myofilaments.
#33) Place the following muscular structures in order from smallest to largest: actin, fascicle, myocyte, myofibril, myosin, sarcomere.
Actin
Myosin
Sarcomere
Myofibril
Myocyte
Fascicle