Past Papers · SAQ
Neuromuscular Transmission
2026B Q15
Exam questiona) Outline the structure of the neuromuscular junction (NMJ), including the location of receptors and enzymes (30% of marks).
A diagram may assist in your answer but is not mandatory.
b) Explain the events that occur at the NMJ that lead to the onset and offset of a muscle (motor end plate) action potential (70% of marks).
A description of excitation/contraction coupling is NOT required.
CICMWrecks answer
Master answer
Neuromuscular Transmission
- In nerve cells, a reduction in cell membrane potential above RMP (ie. – 70mV) results in a voltage dependent increase in Na+ permeability.
- the wave of excitation moves along the axon unidirectionally at a constant amplitude & velocity.
- At the neuromuscular junction presynaptic motor axons terminate 30 nanometers from the cell membrane or sarcolemma of a muscle fiber.
- The sarcolemma at the junction has invaginations called postjunctional folds, which increase its surface area facing the synaptic cleft.
- These postjunctional folds form the motor endplate, which is studded with nicotinic acetylcholine receptors (nAChRs)
Neuromuscular Junction
Acetyl Choline:
- stored in vesicles within the terminal button
- approx. 10,000 molecules in each vesicle
- 3 pools (1% immediately releasable, 80% readily releasable, rest stationary store)
- Ach inhibits Choline Acetyltransferase

- Vesicles exocytose in response to depolarization of presynaptic terminal and influx of calcium
- Acetylcholine released into the synaptic cleft
- Pyruvate in Mitochondria → Acetyl-CoA
- Choline – 50% from extracellular (diet) + 50% recycled from Ach
ACh Receptor
- Nicotinic subtype
- 5 polypeptide subunits – ring structure with central pore
- Two α (Bind ACh), One β, One g, One δ
- Locations:
- Post junctional membrane receptors on motor end plate
- Extra-junctional
- Pre-junctional
Activation:
- Ach bind to alpha subunits → opens the ion gated channed
- Movement of all cations, but mainly sodium → depolarizes membrane
- Once reaches threshold of -50mV (from resting of -80) → voltage gated sodium channels open → rapid depolarization → end plate potential (EPP) of 50-100mV
- This triggers muscle action potential → muscle contraction
- Muscle AP propogates along muscle membrane to cause contraction
- Pre-junctional receptors → positive feedback → increased Ach by second messenges system
- Play role in “fade” seen in non-depolarizing muscle blockers
Fate:
- Acetyl choline hydrolysed to choline and acetate by AChE (Acetyl Choline Esterase)
- Breakdown is very rapid, so the inward current through receptor is transient, followed by rapid repolarisation to resting state
Sources:
AnaesthesiaUK
Arthur Karlin, Nicotinic Acetylcholine receptors, Nature reviews Neuroscience
JC 2019
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Quick reference
Summary
| NMJ | Key point |
|---|---|
| Structure | Motor nerve terminal with ACh vesicles and voltage-gated Ca2+ channels; synaptic cleft with AChE; folded motor end plate rich in nicotinic Nm receptors and nearby voltage-gated Na+ channels |
| Onset | Nerve AP → Ca2+ influx → ACh exocytosis → Nm receptor opening → Na+ influx/end-plate potential → muscle voltage-gated Na+ channels → muscle AP |
| Offset | ACh rapidly hydrolysed by acetylcholinesterase; choline is taken back up for ACh resynthesis and presynaptic Ca2+ is cleared |
Past papers
Exam appearances
| Exam | Exact exam wording | Candidate success |
|---|---|---|
| 2026B Q15 | a) Outline the structure of the neuromuscular junction (NMJ), including the location of receptors and enzymes (30% of marks). A diagram may assist in your answer but is not mandatory. b) Explain the events that occur at the NMJ that lead to the onset and offset of a muscle (motor end plate) action potential (70% of marks). A description of excitation/contraction coupling is NOT required. | — |
| 2025A Q14 | (a) Describe the structure of the neuromuscular junction (NMJ), including the location of receptors and enzymes (a diagram may assist in your answer but is not required to achieve full marks) (30% of marks). (b) Explain the events that occur at the NMJ that lead to the onset and offset of a muscle/motor end plate action potential (a description of excitation/contraction coupling is NOT required) (70% of marks). | 76% |
| 2019A Q17 | Explain the physiology of neuromuscular transmission. | 60% |