Exam III DB Flashcards by Amanda Pearman

Drunk female is struck by a pickup; the bumper impacted right on the patella and resulted in a traumatic knee dislocation. Her orthopedic evaluation should address the integrity popliteal fossa structures with special attention to the:

a. Sciatic nerve
b. Popliteal vein
c. Popliteal artery
d. Tibial nerve

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The fascia lata is attached to:

a. Lateral intermuscular septum
b. Medial intermuscular septum
c. Iliotibial tract
d. All of the above

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3) Which hamstring muscle provides a protective covering over the sciatic nerve as it descends in the posterior thigh?

a. Semitendinosus
b. Semimembranosus
c. Long head biceps femoris
d. Short head biceps femoris

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The lower extremity plays an important role in all of the following EXCEPT:

a. Locomotion
b. Maintenance of balance
c. Supporting the body
d. Manipulation

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5) The triceps coxae includes the following muscles

a. Obturator externus
b. Obturator internus
c. Gemelli superior
d. Gemelli inferior

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6) Rapidly enlarging mass in the lateral inferior quadrant of the gluteal region. MRI indicates myosarcoma at the insertion of the piriformis. Evidence of nerve compression would likely first appear as:

a. Weakened thigh extension
b. Weakened leg flexion
c. Weakened leg extension
d. Weakened medial thigh rotation

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a. Weakened thigh medial rotation
b. Weakened leg flexion
c. Weakened trunk extension when the thigh is fixed
d. All of the above

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7) Male has rapidly enlarging mass in the lateral inferior sacral region. Radiologic analysis including MRI and angiography indicate a pseudoaneurysm of the inferior gluteal artery at the greater sciatic foramen. Evidence of nerve compression would likely first appear as:
a. Weakened thigh medial rotation
b. Weakened leg flexion
c. Weakened trunk extension when the thigh is fixed
d. All of the above

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The angle of inclination of the femoral head:

a. Increases with age
b. Decreases with age
c. Remains stable unless there is a non-healing fracture
d. Is the same for males and females

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13) The inferiorly directed structure beginning at “C” (the adductor canal) in the above picture contains:

a. The femoral artery
b. The femoral nerve
c. Both
d. Neither

Also includes:
Femoral vein
Saphenous nerve

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(tensor fascia latae) is an antagonist to muscles innervated by the:

a. superior gluteal nerve
b. inferior gluteal nerve
c. anterior rami of L2, 3 & 4
d. femoral nerve

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What is true about the vastus lateralis?

a. Is a thigh flexor
b. Is a knee flexor
c. Both
d. Neither

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The iliacus muscle:

a. Forms the medial floor of the femoral triangle
b. Is a weak femur flexor
c. Is innervated by the femoral nerve
d. All of the above

Also, is a femur flexor

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The vastus lateralis:

a. Is the only quad muscle not innervated by the femoral nerve
b. Arises from the posterior aspect of the femur proximally and distally
c. Has a distal insertion of the fibula
d. Is an antagonist of the vastus intermedius

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The articular muscle of the knee (articularis genu):

a. Is innervated by the femoral nerve
b. Functions to distract the synovial membrane of the knee to prevent its compression between the femur and patella
c. Is a weak knee extensor
d. All of the above

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The following regarding the femoral hernias are accurate

a. They occur more often in women than men
b. They’re easily differentiated from inguinal hernias on physical examinations – Spring ’13, Summer ’13 answer
c. They commonly present with intestinal strangulation
d. They consist of a loop of intestine passing inferiorly through the femoral canal
e. They function in stabilizing the pelvis in normal ambulation – Spring ’14 answer

B & E

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With respect to the adductor muscles (longus, brevis, magnus):

a. Cutting the obturator nerve completely eliminates thigh adduction
b. They function in stabilizing the pelvis in normal ambulation
c. They are only innervated by the obturator nerve
d. A significant decrease in function must occur before it becomes clinically evident

B & D

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The artery to the sciatic nerve is a branch of the:

a. Femoral artery
b. Superior gluteal artery
c. Inferior gluteal artery
d. Obturator artery

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The following statements regarding the gluteus maximus are accurate EXCEPT:

a. It is the largest muscle in the body
b. It inserts on the iliotibial tract and gluteal tubercle of the femur
c. It plays a major role in hip abduction
d. It is a strong hip extender
e. The superior portion is supplied by the superior gluteal nerve

C & E

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With the LE fixed, the gluteus maximus becomes

a. A powerful trunk extender
b. A powerful trunk flexor
c. Unable to function effectively
d. A weak trunk flexor

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ID the following statement regarding hamstring injuries that is the least accurate:

a. The semitendinosus is most often injured
b. Most injuries occur in the process of decelerating the tibia
c. The risk of hamstring injury increases with age
d. Hamstring strengthening decreases the risk of injury

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ID the hamstring muscle innervated by the tibial division of the sciatic nerve:

a. Semitendinosus
b. Semimembranosus
c. Biceps femoris
d. All innervated by the tibial division

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26) ID the hamstring muscle innervated by the fibular division of the sciatic nerve:
a. Semitendinosus
b. Semimembranosus
c. Long head biceps femoris
d. Short head biceps femoris

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The following statements accurately describe the femoral nerve EXCEPT:

a. The femoral nerve is composed of nerve roots from L2, L3, and L4
b. Passes beneath the inguinal canal medial to the femoral artery
c. Forms the psoas muscle in the abdomen
d. Supplies the anterior compartment of the thigh

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The obturator nerve a. Supplies all the muscles that adduct the thigh b. Is composed of sacral nerve roots c. Passes through the obturator canal d. All are correct

C **Also: Splits into anterior and posterior branches that surround the adductor brevis AND Supplies the muscle of the medial compartment of the thigh**

The perforating arteries of the profunda femoris supply blood to: a. The anterior compartment of the thigh b. The medial compartment of the thigh c. The posterior compartment of the thigh d. All of the above

All the posterior compartment thigh muscles except the short head of the biceps femoris originate from: a. Inferior pubic ramus b. Ischial ramus c. Ischial tuberosity d. Ischial spine

All the posterior compartment thigh muscles have an origin on the: a. Inferior pubic ramus b. Ischial ramus c. Ischial tuberosity d. Ischial spine

All muscles of the posterior compartment of the thigh cross 2 joints EXCEPT: a. Semimembranosus b. Semitendinosus c. Long head of the biceps femoris d. Short head of the biceps femoris

The iliopsoas muscle complex is innervated by: a. The ventral rami of L1-L3 b. The femoral nerve c. Both A and B d. Neither A nor B

The iliopsoas muscle complex: a. Extends the trunk when the thigh is fixed b. Is the strongest hip flexor c. Is innervated solely by the femoral nerve d. All of the above

The anterior thigh muscle that flexes the femur/hip is the a. Vastus lateralis b. Rectus femoris c. Vastus intermedius d. All of the above

The psoas muscle originates from the a. Iliac fossa b. TVPS and bodies of L1-L3 c. Medial sacrum d. PSIS

Stab wound to the right inguinal area which completely lacerates the iliopsoas muscle and femoral nerve just inferior to the inguinal ligament. The femoral pulse is strong and there is minimal bleeding. You are surprised to find: a. Absent thigh flexion b. Slightly weakened thigh adduction c. Normal thigh extension d. Absent knee extension You are not surprised to find a. Absent thigh flexion b. Severely weakened thigh flexion c. Weak knee extension d. Severely weakened thigh extension

A B

Jack Bauer is severely injured by the KGB trained Peruvian Ninja assassin. He receives a stab wound to the right inguinal area which completely lacerates the iliopsoas muscle and the femoral nerve just superior to the inguinal ligament. You administer first aid; the femoral pulse is strong and there is minimal bleeding. You are surprised to find: a. Moderately weakened knee extension (3/5) b. Moderately weakened thigh flexion (3/5) c. Normal thigh extension (5/5) d. Slightly weakened thigh adduction (4+/5)

A **Also, weakened knee extension (severely)**

The distal semimembranosus forms the a. Popliteal fascia b. Oblique popliteal ligament c. Insertion on the medial tibial condyle d. All of the above

The rectus femoris originates from the a. Ilium superior to the acetabulum b. ASIS c. Both A and B d. Neither A nor B

A **ALSO: AIIS**

The tibial division of the sciatic nerve supplies all of the following muscles EXCEPT: a. Long head of biceps femoris b. Hamstring portion of the adductor magnus c. Semimembranosus d. All are innervated by the tibial division of the sciatic nerve

The tibial division of the sciatic nerve supplies to which of these muscle? a. Biceps femoris b. Adductor magnus c. Semimebranosus d. All are innervated solely by the tibial division of the sciatic nerve

The tibial division of the sciatic nerve is the complete innervation to which of these muscles? a. Biceps femoris b. Adductor magnus c. Semimembranosus d. All are innervated by the tibial division of the sciatic nerve

Which muscles contribute to the pes anserinus: a. Gracilis b. Sartorius c. Semitendinosus d. All of the above

When the thigh and leg are fixed, which muscle group flexes the trunk? a. Gluteal muscles b. Quadriceps c. Hamstrings d. All flex the trunk

B **ALSO: Pectineus Tensor of the fascia lata**

All of the gluteal muscles act as medial thigh rotators EXCEPT: a. Gluteus Maximus b. Gluteus Minimus c. Gluteus Medius d. All of the above

Which muscles act as antagonists to the gluteus maximus? a. Iliacus b. Psoas c. Rectus femoris d. All of the above

Infection in the great toe, infiltrated the proximal lymph nodes, complete compressive mononeuropathy (only one nerve is NOT functioning) because of the following LE movements is completely absent a. Thigh flexion b. Extension of the knee c. Adduction of the thigh d. Extension of the thigh This movement is severely weakened but present a. Lateral rotation of the thigh b. Extension of the knee c. Adduction of the thigh d. Flexion of the thigh The paralysis is incomplete because which nerve remains intact a. Obturator b. Inferior gluteal c. Superior gluteal d. femoral

B C D

Which anterior compartment muscles crosses the largest number of joints: a. Rectus femoris b. Iliacus c. Psoas d. Sartorius

C ***After Psoas, the next largest is the Rectus Femoris**

The interosseous membrane in the LE does all the following EXCEPT: a. Separates the anterior and posterior compartment b. Site of muscular origin c. Force transmission d. All are functions of the LE interosseous membrane

Which structure goes out the greater sciatic foramen and enters the lesser sciatic foramen: a. Pudendal nerve b. Sciatic nerve c. Obturator externus d. Inferior gluteal artery e. Internal pudendal artery

A & E

Injury to the fibular component of the sciatic nerve would weaken a. Thigh extension b. Knee flexion c. Both d. Neither

Which individual would most likely have the largest angle of inclination of the femur? a. A Kalahari bushman whose daily foraging trips cover 12-15 miles a day b. A sedentary suburbanite who drives 45 miles one to work and spends his free time playing video games in his parents basement c. A Mexican subsistence farmer who uses only animal power on his farm d. A 98 year-old female nursing home resident and former elite race walker e. An executive secretary that commutes 53 miles to work each day from a rail station located 400 meters from his home and spends 90% of his free time playing video games in his parents’ basement located next door to his home

B & E

Which individual would most likely have the least angle of inclination of the femur? a. A Kalahari bushman whose daily foraging trips cover 14-18 miles a day b. An executive secretary that commutes 53 miles to work each day from a rail station located 400 meters from his home and spends 90% of his free time playing video games in his parents’ basement located next door to his home c. A Mexican subsistence farmer who uses only animal power on his farm d. A 98 year-old female nursing home resident and former elite race walker

All of the following muscles play a role in lateral thigh rotation of the femur EXCEPT: a. Gluteus maximus b. Gluteus medius c. Tensor of the fascia lata d. All play a role in lateral rotation

Which of the following muscles are involved in lateral rotation of the femur? a. Gluteus maximus b. Gluteus medius c. Tensor of the fascia lata d. All play a role in lateral rotation

The tensor of the fascia lata and the gluteus maximus are: a. Synergist b. Antagonist c. Both d. Neither

The anterior thigh muscle that extends the knee is the a. Vastus lateralis b. Rectus femoris c. Vastus intermedius d. All of the above

Which of the following muscles is not an adductor of the femur? a. Adductor magnus b. Obturator externus c. Pectineus d. All are adductors of the femur

All of the following muscles insert on the greater trochanter of the femur EXCEPT: a. Piriformis b. Superior gemelli c. Obturator internus d. Inferior gemelli e. All insert on the greater trochanter of the femur

Identify the muscle with single origin a. Biceps femoris b. Rectus femoris c. Iliopsoas d. None of these have a single origin

Which of the following muscles play a role in medial rotation of the femur? a. Gluteus maximus b. Gluteus medius c. Tensor of the fascia lata d. All play a role in medial rotation

With the LE fixed, the iliacus becomes: a. A trunk extender b. A trunk flexor c. Unable to function effectively d. A weak trunk flexor

Identify the hamstring muscle that is innervated by the fibular division of the sciatic nerve a. Semitendinosus b. Semimembranosus c. Biceps femoris d. All are innervated by the fibular division

Complete interruption of the obturator nerve in pelvis would: a. Weaken medial rotation b. Weaken lateral rotation c. Both d. Neither

Injury to which of the following nerves would most weaken lateral rotation of the thigh? a. Superior gluteal nerve b. Nerve to the piriformis c. Nerve to the obturator internus d. Nerve to the quadratus femoris

Which of the following muscles is not a lateral rotator of the thigh? a. Gluteus maximus b. Obturator externus c. Obturator internus d. All are lateral rotators

D ***ALSO* Gluteus minimis**

The vastus medialis a. Is the only quadriceps muscle not innervated by the femoral nerve b. Has an origin from the intertrochanteric line c. Arises from the medial lip of the linea aspera d. Has a distal insertion of the fibula

Identify the following statement regarding hamstring injuries that is the least accurate: a. The biceps femoris is most often injured b. Most injuries occur in the process of an concentric contraction c. The risk of hamstring injury increases with age (and that’s just not fair) d. Hamstring strengthening decreases the risk of injury

Karl Spacker has developed left sided abdominal pain and left lower extremity weakness to the point that he is unable to perform his duties. His physician has ordered a CT scan of his abdomen and pelvis. Karl is diagnosed with a chinch bug larva abscessed of the left psoas muscle. Physical examination reveals marked left sided abdominal tenderness and likely motor findings would include: a. Impaired femur flexion b. Impaired femur lateral rotation c. Both d. Neither

D **ALSO- Impaired medial femur rotation**

Which of the following structures are not involved in the formation of the floor of the femoral triangle? a. Iliacus b. Pectineus c. Adductor brevis d. All are components of the floor of the femoral triangle

Identify the structure that does not enter the adductor canal. a. Femoral artery b. Femoral vein c. Femoral nerve d. All enter the adductor canal

The most common variation of sciatic nerve anatomy as it exits from the area of the piriformis a. The tibial division passes through the muscle with the fibular division passing inferior to the muscle b. The tibial division exits superior to the muscle while the fibular division exits below c. Both tibial and fibular divisions pass through the muscle d. None of the above

Which posterior thigh muscle has a simple insertion (i.e. a single connective tissue element inserting on to a single bony prominence)? a. Biceps femoris b. Semimembranosus c. Semitendinosus d. None have simple insertions

Active movement of the following anatomic structures involves dual peripheral innervations EXCEPT: a. Adductor magnus b. Iliotibial tract c. Biceps femoris d. All involve dual peripheral innervation

The following structures emerge directly below the inferior border of the piriformis muscle EXCEPT: a. Obturator nerve b. Sciatic nerve c. Inferior gluteal artery d. Inferior gluteal nerve

ID the strongest lateral rotator of the thigh: a. Gluteus medius b. Gluteus maximus c. Obturator internus d. Quadratus femoris

Piriformis syndrom is most often caused by: a. Compression of lumbosacral nerve roots as they exit the spinal canal b. Irritation of the sciatic nerve just proximal to its bifurcation in the popliteal fossa c. Piriformis muscle spasm d. A weak piriformis muscle

Piriformis syndrom differs from sciatica by: a. The distribution of the sensory deficits b. The cause c. Distribution of weakness d. All of the above

Which hamstring muscle has an insertion that reinforces the intercondylar part of the knee capsule? a. Semtendinosus b. Semimembranosus c. Long head biceps femoris d. Short head biceps femoris

The following statements regarding the sciatic nerve are accurate except: a. The sciatic nerve supplies a small number of gluteal muscles OR it supplies the coxae muscles b. It is the largest nerve in the body c. It is large enough to have its own named arterial supply d. As it passes from beneath the piriformis muscles it is lateral to the inferior gluteal artery & nerve

The femoral artery supplies all of the following except: a. The anterior compartment b. The head and neck of femur c. The gluteal muscles d. The profunda femoris

ID the medial compartment muscle that crosses two joints: a. Adductor magnus (hamstring part) b. Adductor longus c. Adductor magnus (adductor part) d. Gracilis

This medial thigh muscle assists in stabilizing the head of the femur in the acetabulum: a. Adductor magnus b. Adductor brevis c. Obturator externus d. Gracilis

ID the anterior compartment muscle that from a functional standpoint would be more appropriately placed in the medial compartment: a. Adductor brevis b. Sartorius c. Pectineus d. Vastus medialis

The following statements regarding the popliteal artery are accurate except: a. It supplies the major branches involved in the perigenicular anastomotic network b. It is located superficial to the popliteal vein in the popliteal fossa c. It is at risk for injury in knee dislocations d. Chronic repetitive flexion/extension cycles may play a role in the development of popliteal artery aneurysms

Leg flexors are supplied by which of the following nerves: a. Sciatic nerve b. Femoral nerve c. Obturator nerve d. All of the above

The hamstring part of the adductor magus: a. Is innervated by the obturator nerve b. Acts as a thigh adductor c. Is located medial to the adductor part d. Is innervated by the fibular division of the sciatic nerve

Electrical stimulation of the superior gluteal nerve would cause: a. Thigh abduction b. Thigh flexion c. Both d. Neither

Which muscle is not innervated by the superior gluteal nerve? a. Gluteus maximus b. Gluteus medius c. Gluteus minimus d. Tensor of the fascia lata

The iliacus muscle inserts on the: a. Greater trochanter b. Lesser trochanter c. Iliac tubercle d. Intertrochanteric fossa

All muscles of the posterior compartment of the thigh extend the thigh and flex the leg EXCEPT: a. Semitendinosus b. Long head of the biceps femoris c. Short head of the biceps femoris d. All extend the thigh and flex the leg

ID the adductor muscles innervated by the obturator nerve: a. Adductor magnus (adductor part) b. Gracilis c. Pectinues d. All are correct

The adductor part of the adductor magnus: a. Is innervated by the obtuator nerve b. Acts as a thigh extensor c. Is located lateral to the gluteus maximus d. All of the above

Contents of the proximal adductor canal include the following EXCEPT: a. Femoral artery b. Saphenous nerve c. Femoral nerve d. Femoral vein

Injury to the superior gluteal nerve would impair: a. Flexion b. Medial rotation c. Lateral rotation d. All would be impaired

The inferior gluteal nerve supplies: a. Gluteus minimus b. Gluteus maximus c. Tensor of the fascia lata d. Both a & c

The strongest lateral rotator of the thigh is innervated by the: a. Superior gluteal nerve b. Inferior gluteal nerve c. Obturator nerve d. Nerve to the quadratus femoris

A 48 year old male has a rapidly enlarging mass in the lateral inferior sacral region. Radiologic analysis including MRI and angiography indicate a pseudoaneurysm of the inferior superior gluteal artery at the greater sciatic foramen. Evidence of nerve compression would likely first appear as: a. Weakened thigh abduction b. Weakened thigh flexion c. Weakened medial rotation d. All of the above

With the lower extremity fixed the iliacus becomes: a. A trunk extender b. A trunk flexor c. Unable to function effectively d. A weak trunk flexor

All the medial compartment thigh muscles have an origin on the: a. Pubic ramus b. Ishial ramus c. Ishial tuberosity d. Superior pubic ramus

Ginger Grant is a 57 yo obese whit female (yes that Ginger Grant; rescued from the island after being marooned for 14 years she returned to Hollywood only to be passed over for the role of Ginger in the major motion picture depicting the castaways’ experience, she was told she was too old (I think they picked Lindsey Lohan) this led to a prolonged bout of emotional eating mostly highly decorated full sized sheet cakes.) She reports severe pain centered on the umbilicus which is colicky in nature, her abdomen is distended and extremely tense and tender to palpation. Bowel sounds are virtually absent. She is diagnoses with an acute small intestinal obstruction due to a femoral hernia. Identify the least accurate statement regarding this case. a. A small, tender, tense mass is present in the proximal left thigh b. When asked to couch while to mass was palpated produced no palpable change in the mass c. The left thigh mass was localized to below the medial to the left pubic tubercle d. All are accurate statements

Wilma Flintstone was selling methamphetamine (Fred lost his quarry job began drinking then began using rock (a particularly addictive from of crack cocaine available in Bedrock) and was convicted for selling stolen jewels (fencing “hot rocks”). He is currently incarcerated for a term not to exceed 10 years, Wilma’s got a baby to fee) and got involved in a knife fight with a competitor, another female Ms. B rubble. The knife entered the front of her right thigh and severed the trunk of the right femoral nerve just below the inguinal ligament. Careful examination of Ms. Flintstone would reveal all of the following except: a. Loss of right quadriceps function (0/5) b. Loss of sensation on the medial leg extending to below the medial malleolus to the midshaft of the 1st metatarsal c. Severely weakened hip flexion (2/5) d. All would be present