Doctors Acadamy - Lower Limb COPY

Question 1

What structures are found in the anterior compartment of the lower leg?

Answer 1

Muscles:

1. Tibialis Anterior
2. Extensor Digitorum Longus
3. Extensor Hallicus Longus
4. Peroneus Tertius (Fubularis Tertius)

Nerves: Deep peroneal Nerve

Artery: Anterior Tibial Artery

Question 2

What are the boundaries of the anterior compartment?

Answer 2

Posteriorally - Interosios Membrane (between the bone)
Medially - Tibia
Laterally - Anterior Intermuscular Septum (between anterior and lateral compartments)

Question 3

What structures are found in the lateral compartment of the lower leg?

Answer 3

Muscles:

1. Fibularis longus
2. fibularis brevis

Nerve: Superficial Peroneal nerve

Question 4

what are the boundaries of the lateral compartment?

Answer 4

Anterior - Anterior inter-muscular septum
Medial - fibula
Posterior = Posterior inter-musclar septum

Question 5

What structures are found in the Deep posterior compartment of the lower leg?

Answer 5

Muscles:

1. Tibialis posterior
2. flexor hallicus longus
3. flexor digitorum longus
4. popliteus

Nerve: Tibial Nerve

Artery: posterial tibial artery

Question 6

what are the boundaries of the deep posterior compartment?

Answer 6

anterior - interosis membrane
medial - tibia
lateral - fibula
posterior - flexor hallicus longus

Question 7

What structures are found in the Superficial deep compartment of the lower leg and what the compartments nervous innervation?

Answer 7

Muscles:

1. soleus
2. plantaris
3. gastroneumis (medial and lateral head)

Nerves in comparement: Sural Nerve

Vessels in the compartment: Long Saphenous vein

Nervous innervation: Tibial nerve

Question 8

What does the sural nerve inovate?

Answer 8

The sural nerve does not innervate any muscles.

Supplies sensation to the skin of the lateral foot and lateral lower ankle.

Question 9

damage to what nerve causes foot drop

Answer 9

common peroneal or sciatic nerve

Question 10

What muscles are found in the Medial compartment of the thigh and what is their nerveous innervation?

Answer 10

1. Pectineus
2. Gracillis
3. Obturator externus
4. Adductor Longus
5. Adductor Brevis
6. Adductor Magnus

Innervation:

• Pectineus: Femoral Nerve
• Adductor Magnus: Sciatic Nerve
• All the rest are the obturator Nerve

Question 11

What muscles are found in the Posterior Compartment of the thigh and what is their nervous innervation?

Answer 11

1. Long and short head of the Biceps Femoris
2. Semimembranous
3. Semitendinous

Innervation: Sciatic Nerve

Question 12

What Muscles are found in the Anterior compartment of the thigh and what is there nervous innervation?

Answer 12

1. Vastas Lateralis
2. Vastas Intermedius
3. Vastas Medialis
4. rectus Femoris
5. Sartorius

(Psoas and Ileacus also terminate here at the top)

Innervation: Femoral Nerve (superficial branch)

(Psoas: anterior rami L1-L3)

(Ileacus: Femoral nerve)

Question 13

Name the structures found within the popliteal fossa (posterior to anterior)

Answer 13

1. Tibial Nerve
2. Popliteal Vein
3. Popliteal Artery
4. Popliteus and capsule (inferiorlly)
5. Oblique popliteal ligament (in the middle)
6. posterior cruciate ligament

Question 14

What are the boarders of the popliteal fossa?

Answer 14

Superior - lateral: Biceps femoris

Superior Medial: Semi tendinosus

Inferiorally: two heads of the gastroneumeus

Question 15

What muscles are responsible for locking and unlocking the knee?

Answer 15

Locking: Tensor fascia lata

Unlocking: Popliteus

Question 16

What ligaments make up the deltoid ligament?

Answer 16

• Anterior and posterior tibiotalar
• Tibionavicular
• Tibiocalconeal

Question 17

what ligaments make up the lateral ankle ligaments?

Answer 17

1. Anterior and posteria talofibular
2. Calconeofibular

Question 18

What three tendons make up the pes anserine?

Answer 18

sartorius, gracilis, and semitendinosus.

Question 19

what is the petella tendon a continuation of

Answer 19

The quadraceps tendon

Question 20

what symptoms do you get ina femoral nerve injury

Answer 20

• unablet to extend leg or knee
• loss of sensation to medial leg

Question 21

what symptoms do you get in a common peroneal nerve injury

Answer 21

• foot drop
• reduced inversion of the foot (only tibialis anterior affected)
• eversion lost
• reduced sensation of dorsal surface of foot

Question 22

what muscles are responsible for inversion of the foot

Answer 22

tibialis anterior and posterior

Question 23

what muscles are responsible for eversion of the foot

Answer 23

fibularis longus and brevis

Question 24

what symptoms do you get in deep peroneal nerve injury

Answer 24

• partial foot drop
• loss of sensation 1st dorsal webspace

Question 25

what symptoms do you get in superficial peroneal nerve injury

Answer 25

* loss of sensation of 2/3/4th webspace * loss of eversion

Question 26

what syptoms do you get in tibial nerve injury

Answer 26

* loss of plantarflexion * weak inversion

Question 27

What are the treatment options for a femoral shaft fracture?

Answer 27

1. IM nail and cannulated screws 2. if fracture invovles the joint - plate and screws

Question 28

What are the treatment options for patella fractures?

Answer 28

* If \<2mm displacment and NO extensor lag = Conservative * if \>2mm displacement or extensor lag = tension wire banding * if shattered = patellectomy

Question 29

What are the features of an ACL tear and what is the typical mode of action?

Answer 29

* Immediate swelling (haemarthrosis) * often a high twisting force applied to a bent knee

Question 30

What are the features of an PCL tear and what is the typical mode of action?

Answer 30

* Immediate swelling (Haemarthrosis) * hyperextension injuries

Question 31

What is the typical mode of action of a medial colateral ligament tear

Answer 31

lef forced in to valgus via a force from outside the leg

Question 32

What are the features of an meniscal tear and what is the typical mode of action?

Answer 32

Features: * delayed onset of knee swelling * joint locking Mode of action: rotational sports injury

Question 33

What are the common features of Chondromalacia patellae

Answer 33

* Common in teenage girls * pain on walking down the stairs and at rest * tenderness over patella and quadraceps wasting

Question 34

What are the common features of Pes Anserine bursitis?

Answer 34

* Pain on medial side of knee approx. 2cm below joint * pain on walking up or down stairs or on excersise

Question 35

What nerves are at risk in following hip approaches? 1. Anterior 2 Anterior-lateral 3. Posterior

Answer 35

Anterior = lateral cutaneous nerve of the thigh Anterio-lateral = superior gluteal nerve Posterior = sciatic nerve

Question 36

What happens in osteoporosis and what is the classical presentation? what is the treatment?

Answer 36

what happens: Decrease in osteoid matrex but normal mineralisation. Therefore the bone trabeculae is significantly thinned and lacks strength. Presentation: Pathological fractures Treatment: Vitamin D, Calcium, Bisphosphonates

Question 37

What happens in osteomalacia and what is the classical presentation? what is the treatment?

Answer 37

What happens: normal boney tissue but decreased mineral cortex. Features: Rickets, bone pain, fractures, muscle tenderness Treatment: Vitamin D + calcium

Question 38

What happens in osteopetrosis and what is the classical presentation? what is the treatment?

Answer 38

What happens: Marble bone disease. Decfective osteoclasts - failure of bone reabsorbtion which leads to abnormally dense, brillte bone treatment: Bone marrow transplant

Question 39

What is osteogenisis imperfecta and wahat are the common features?

Answer 39

Features: * Failure of maturation of collagen in connective tissue * Vision problems (glaucoma) * Patients may have hypermobile joints Radiologically: * translucent bone * multiple fractures of long bones. Ttreatment * physiotherapy

Question 40

What is perthes disease and what features are commonly associated with it? What age dose it commonly occur?

Answer 40

Perthes: Avascular necrosis of the femoral head Features: associated with being short and overactive Age: 5-12yrs

Question 41

What is the first sign of perthes disease on an xray?

Answer 41

1st sign = sclerosis Then you get a flatterned or fragmented femoral head and subchondral collapse

Question 42

What features are commonly associated with SUFE and what age does it occur?

Answer 42

Associciated Features: Obese children, hypothyroid and GH defficiency Age: 13/14

Question 43

What features do you see on an xray in a child with a SUFE?

Answer 43

displaced femoral head

Question 44

What are the nerve roots of the sciatic nerve

Answer 44

L4-S3

Question 45

Where does the common peroneal nerve bifurcate into the superficial and deep peroneal nerves

Answer 45

The common peroneal nerve bifurcates at the neck of the fibula (where it is most likely to be injured).

Question 46

If an x ray showed brodies abscessess and sequestrium what condition would that indicate?

Answer 46

Osteomylitis

Question 47

If an xray showed subchondral sclerosis what condition would that indicate

Answer 47

osteoartheritis

Question 48

what biochemical changes do you get in osteomalacial

Answer 48

low calcium low phosphate high ALP

Question 49

What biochemical changes do you get in Padgets

Answer 49

Calcium and Phosphate are normal ALP high

Question 50

on a dexa scan, what would the following values indicate: * -1 to 1 * -1 to -2.5 *

Answer 50

- 1 to 1 = normal - 1 to -2.5 = Osteopenia less than -2.5 = osteoporosis

Question 51

in what condition dobrowns tumours occur?

Answer 51

Hyperparathyroid

Question 52

what can be seen on an x ray in a patient with osteopetrosis

Answer 52

lack of differentiation between the cortex and medulla

Question 53

what are some of the features of rickets?

Answer 53

Large head bowing of the legs deformity of the chest wall xray shows cupping

Question 54

Describe a Smiths Fracture

Answer 54

Distal radius fracture with volar angulation

Question 55

Descibe a Collies Fracture

Answer 55

Distal radius fracture + dorsal angulation

Question 56

What is a Holstein Lewis Fracture

Answer 56

A HolsteinLewis fracture is a fracture of the distal third of the humerus resulting in entrapment of the radial nerve Conservative treatment includes reduction and use of a functional brace Vascular injury may require open surgery

Question 57

What is a bennetts fracture

Answer 57

Compresesion fracture of the base of the first metacarpal

Question 58

What structures pass posteriorally to the Medial Maleolus?

Answer 58

Tom Dick And Nervous Harry * Tibailis Posterior Tendon * Flexor Digitorum Longus * Posterior Tibial Artery * Tibial Nerve * Halicus Longus

Question 59

What structures pass posteriorally to the lateral maleolus

Answer 59

superficial to superior peroneal retinaculum * Sural nerve * Short saphenous vein deep to superior peroneal retinaculum * Peroneus longus tendon * Peroneus brevis tendon

Question 60

What is the blood supply to the scaphoid bone?

Answer 60

Dorsal carpal branches

Question 61

What is the treatment for distal radial fractures?

Answer 61

Treatment is mostly conservative, if affecting the joint surface or angulated then for surgical fixation

Question 62

What is the treatment for proximal humeral fractures?

Answer 62

1. If impacted - Colar and cuff 2. if displaced - ORIF

Question 63

An 18 year old athlete attends orthopaedic clinic reporting pain and swelling over the medial aspect of the knee joint. The pain occurs when climbing the stairs, but is not present when walking on flat ground. Clinically there is pain over the medial, proximal tibia and the McMurray test is negative. What is the most likely cause of this patient's symptoms?

Answer 63

Pes anserinus bursitis

Question 64

what are the bounaries of the adductor canal?

Answer 64

Anterior Medially - Sartorius Anterior Laterally - Vastas Medialis Posteriorally - adductor longus and magnas

Question 65

A decision is made to perform a hemi arthroplasty through a lateral approach. Which vessel will be divided to facilitate access?

Answer 65

Transverse branch of the lateral circumflex artery

Question 66

Which ligament contains the artery supplying the head of femur in children

Answer 66

ligamentum teres

Question 67

The foramen marking the termination of the adductor canal is located in which muscle

Answer 67

Abductor magnus

Question 68

what is the contents of the adductor cannal?

Answer 68

saphenous nerve, femoral vein and the superficial branch of the femoral artery.

Question 69

what are the boundaries of the adductor canal?

Answer 69

Medially: Sartorius Posteriorally: Adductor longus and magnus Antereolaterally: Vastus Medialis

Question 70

what is the O'Donoghue's triad / the unhappy triad

Answer 70

injury to the anterior cruciate ligament, medial collateral ligament, and meniscus.

Question 71

what is lachmans test

Answer 71

this is a manouver used to test the integrity of the ACL

Question 72

what is the function of the femoral canal

Answer 72

allows for expansion of the femoral vessels

Question 73

what muscles cause hip abduction

Answer 73

Gluteus medius and minimus and TFL

Question 74

what x ray signs do you get in osteoartheritis and what is the first of those sign to appear on an xray?

Answer 74

L - loss of joint space --\> this is the first to appear O - osteophytes S - Subchondral sclerosis S - Subchondral cysts

Question 75

what fracture is most commonly associated with a posterior hip disolocation

Answer 75

acetabulum fracture

Question 76

what is the blood supply of the long and short head of the biceps femoris

Answer 76

The short head of biceps femoris, is innervated by the common peroneal component of the sciatic nerve The long head is innervated by the tibial division of the sciatic nerve.

Question 77

What structures pass anterior to the medial maleolus?

Answer 77

Tibialis anterior

Question 79

What nerve is most commonly damaged in varicose vein surgery

Answer 79

Sural nerve

Question 80

If a young male has symptoms of lower limb ischaemia on exertion what is the top differential diagnosis

Answer 80

Adductor canal compression syndrome

Question 81

What is the pathophysiology of osteopetrosis

Answer 81

Osteoclasts deformity

Question 82

Which ligament connects the ulna to the radial notch

Answer 82

The annular ligament

Question 83

What muscles insert in to the iliotibial tract?

Answer 83

Tensa Fascia Lata (TFL) + Gluteus maximums