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Exam Study Guide for Advanced Patho NRSG 605: Bone, Muscle and Skin Diseases, Neurological Diseases, and Sleep/Pain Diseases

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Exam Study Guide for Advanced Pathophysiology, with subjects including: Bone, Muscle and Skin Diseases, Neurological Diseases, and Sleep/Pain Diseases

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Lesson 14

1. Identify the function of bones.
 Lever
o Upper and lower limbs push and pull
 Calcium store
o 97% of body’s calcium is stored in bone
o Pregnancy and menopause leach the bone of calcium
 Important to take calcium supplements
 Protective
o Most external forces exceed the tolerance of bone
o Ex. skull protects brain
 Marrow holder
o In cavities of unstressed bone

2. Compare and contrast the layers of bone and their functions.
 Periosteum
o Adheres to surface of bone
o Two layers
 Connective tissue
 Dense membranes
o Contains nutrient blood vessels
o During growth and development it contributes to bone elongation
and modeling
o When the bone is injured, participates in its recovery
 Cortical bone (compact)
o 80% of skeletal mass
o Slow turnover
o High resistance to bending and torsion → strength of bone
o Haversian canals
 Tunnel with blood vessels, nerves and lymphatics
 Concentric layers of mineralized bone
 Trabecular bone (spongy)
o 20% of mass
o 80% of bone surface
o High turnover rate
o Composed of bundles of short and parallel stands
o Center contains marrow

3. List the parts of a synovial joint.
 Synovial joint
o Sliding surfaces of bone covered with cartilage
o Joint cavity is sealed with synovial membrane which secretes
synovial fluid

, o Bursa is large area of synovial sac at ends of bone
o Joint cavity may also contain
 Menisci
 a thin fibrous cartilage between the surfaces of some
joints that acts as a shock absorber, ex. the knee
 Discs of cartilage




4. Describe the process of bone remodeling, including factors that stimulate and
inhibit the process.
 Bone remodeling is a continuous process
o Resorption → Reversal → Formation → Quiescence




o Resorption
 Resorption occurs from osteoclastic breakdown of trabecular
bone via secretion of proteolytic enzymes; calcium is then
taken up by osteoclasts and released into circulation
 Resorption exists for two reasons:
 To liberate calcium and other ions
 To clear out worn out pieces of skeleton and promote
the deposition of newer, better material.

, o Reversal
 Mesenchymal stem cells, precursors to osteoblasts, appear
along the burrow where osteoclasts removed bone. These
cells then proliferate and differentiate into pre-osteoblasts
o Formation
 Pre-osteoblasts mature into osteoblasts at the surface of the
burrow and release osteoid at the site, forming a new soft
non-mineralized matrix
 New matrix is later mineralized with calcium and phosphorus
o Quiescence
 Site of remodeling, containing resting lining cells, remains
dormant until the next cycle
 Factors that stimulate bone remodeling
o Systemic Hormones
 Parathyroid Hormone
 Vitamin D
 Parathyroid hormone
 Growth Hormone
 Thyroid Hormone
 Sex hormones**
 Stimulate bone turnover during skeletal growth, but
inhibit turnover during adulthood.
o Locally acting factors
 Interleukin-1
 Parathyroid hormone
 Tumor necrosis factor
 Insulin-like growth factors
 Factors that inhibit bone remodeling
o Systemic Hormones
 Sex hormones**
 Calcitonin
o Locally acting factors
 Mechanical Loading (weight bearing exercises)
 Inhibits bone resorption, but stimulates formation
 Interferon gamma

5. List the three types of muscle and if they are voluntary or involuntary.
 Skeletal muscle
o Voluntarily move the body
o Generally attached to bone
o Organized in fibers rather than cells
o Vary in length
 1mm to 60 cm

,  Smooth muscle
o Involuntary
 Can contract without nerve stimulation
o Found in internal organs, stomach, intestines, blood vessels
 Contracts to move food, move blood, change pupil size
o Organized in spindles
o Surrounded by connective tissue
 No tendons
 Cardiac muscle
o Only found in the heart
o Striated, but involuntary
o Contract without stimulation by CNS
 Sinoatrial node
o Spread the information through gaps in the muscle
o One muscle cell with one nucleus and branching fibers

6. Explain how muscle attaches to bone.
 Muscles attach by
o Tendons
o Aponeurosis = Flat tendon
o Flesh

7. Discuss how muscle tone is maintained.
 Muscles do not snap from relaxation to contraction
o Rather, some motor units or fibers are contracting, some relaxing
and some in stasis providing muscle tone
 Muscle contraction is opposed by
o Passive internal resistance of the muscle or articular tissues
o Opposing muscle and soft tissue
o Inertia of whatever it is trying to move
o Load and gravity

8. Identify how actin and myosin cross link to cause muscle contraction in the
sarcomere.
 The globular heads of myosin bind to actin, forming cross-bridges. The
motor activity of myosin moves its head groups along the actin filament.
This movement slides the actin filaments from both sides of the sarcomere
toward the center of the sarcomere, shortening the sarcomere and
resulting in muscle contraction

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