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Question 1

Posterior Compartment of the leg

Answer 1

Superficial group does plantarflexion, deep group does plantarflexion and inversion

Tibial nerve (L4-S3)
Posterior tibial artery and fibular artery

A: Superficial Group

1. Gastrocnemius: crosses knee and ankle
   O: Medial head- posterior surface, superior to medial condyle of the femur
   Lateral head- posterior surface, superior to lateral condyle of the femur
   I: calcaneal tendon (Achilles tendon) on posterior calcaneus
   A: powerful plantar flexor, weak knee flexor
2. Plantaris- fools neve
   O: supracondylar ridge of femur (is lateral)
   I: calcaneal tendon on posterior calcaneus
   A: plantar flexor, weak knee flexor
3. Soleus-
   O: soleal line (posterior tibia)
   I: calcaneal tendon on posterior calcaneus
   A: plantar flexes ankle (goes towards ground)

B: Deep Group

1. Popliteal- most superior, doesn’t cross ankle, unlocks the knee
   O: lateral femoral condyle
   I: posterior surface of proximal tibia
   A: medially rotates the tibia
2. Tibialis Posterior- helps support the medial arch
   O: posterior tibia, fibula, interosseus membrane
   I: navicular tuberosity, medial cuneiform
   A: inversion, plantarflexion
3. Flexor digitorum longus-
   O: posterior surface of tibia
   I: distal phalanges of lateral 4 toes (plantar surface)
   A: flexes lateral 4 toes, assist with plantar flexion and inversion
4. Flexor hallucis longus-
   O: posterior fibula and interosseus membrane
   I: distal phalanx of great toe
   A: flexes great toe, assist with plantar flexion and inversion

Question 2

Cartilage Growth

Answer 2

1. Appositional- growth by addition to an existing surface, generation of new chondroblasts from chondrogenic cells in the pericbondrium, chondroblasts make ECM and get stuck in lacunae and become chondrocytes
2. Interstitial- growth by internal expansion, proliferation of chondrocytes and formation of isogenous groups, involves mitosis

Question 3

Hyaline cartilage

Answer 3

ECM composition: bunch of water, proteoglycans, GAGs like chondrites sulfate, Type II collagen fibers

Location: articulate cartilage, nose, larynx, tracheal rings, epiphyseal plates, fetal bone models

Perichondrium except at articular surfaces

Chondrogenic Cells in perichondrium and can develop into chondroblasts

Chondroblasts are elliptical shape and have long axis parallel to cartilage surface, can become chondrocytes

Chondrocytes in isogenic groups, most deep group

Interterritorial matrix has more type II collagen and less GAGs so not as dark staining

Question 4

Elastic Cartilage

Answer 4

ECM Composition: same as hyaline cartilage plus elastic fibers

Location: auricle (pinna), auditory canal, auditory (pharyngotympanic) tube, epiglottis

Perichondrium is present

Higher ratio of chondrocytes to matrix than hyaline cartilage, few cells per isogenous group though

Epiglottis has adipose tissue as you age

Question 5

Fibrocartilage

Answer 5

ECM Composition: Type I And II collagen, less proteoglycans than other cartilages

Location: intervertebral discs, pubic symphysis, major tendon-bone anchorages

Perichondrium is absent

Intermediate between dense regular connective tissue and hyaline cartilage, chondrocytes arranged in long rows separated by collagen fibers, acidophilus or pink matrix, withstand shearing forces and compression

Question 6

Bone membranes

Answer 6

1. Periosteum-connected to underlying bone via collagen fibers (Sharpey’s or perforating fibers)

A: Outer- fibrous Layer of Dense Irregular CT
B: Inner- osteogenic Layer of osteogenic Cells, osteoblasts, and osteoclasts

2. Endosteum- covers internal surface of bone, lines cortical Haversian canals, one cell layer thick with osteogenic cells

Question 7

Bone tissue ECM

Answer 7

1. Osteoid (organic): Type I collagen and bone matrix proteins like GAGs (hyaluronic acid and chondroitin sulfate), glycoproteins, osteocalsin, and osteonectin

Osteoclasin- vitamin K dependent polypeptide that promotes calcification of the bone matrix

Osteonectin-multiadhesive glycoproteins specific to bone

2. Inorganic- hydroxyapatite crystals [Ca10(PO4)6(OH)2], represents 50% of dry weight of bone matrix

Question 8

Bone cells

Answer 8

1. Osteogenic Cells- mesenchymal stem cells that divide and differentiate into osteoblasts, found in inner layer of periosteum and in the endosteum
2. Osteoblasts- make organic portion of matrix, activity signals calcification, surface of bone matrix like simple epithelium, become cuboidal and basophilic cytoplasm when make matrix, osteocytes once encase themselves
3. Osteocytes- sit in lacunae, long extensions in canaliculi, reduced rER/Golgi and more condensed chromatin than osteoblasts
4. Osteoclasts- multinucleated cuz form from fusion of monocytes, dissolve bone matrix by secreting enzymes and H+, sit in pits called resorption bays (Howship’s lacunae), ruffled borders where break bone matrix

Question 9

Functions of bone

Answer 9

Protection

Support

Mechanical basis for movement

Storage

Blood cell formation

Question 10

Steps in Motivational Interviewing

Answer 10

1. Assess: open ended questions to assess readiness to change like contemplation/action, assess confidence and 7 is magic number
2. Advise: ask permission and emphasize patient autonomy, ask and tell sequences plus check for understanding
3. Agree: agree on small goals that are realistically achievable, set a behavior and time period for success
4. Assist: help overcome barriers and make action plan, set easier goals if have problems
5. Arrange: arrange follow up, arrange classes or other referrals