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COM: MSK (Midterm) COPY > Lecture 4: Femoral Triangle > Flashcards

Lecture 4: Femoral Triangle Flashcards

1
Q

The news reported that the 58 yo ambassador received a slashing wound to the medial thigh and died from exasanguination in less than 2 minutes. What was the most likely nature of his injury?
A) The femoral artery was cut at the inguinal ligament
B) A vessel or vessels were injured at the apex of the femoral triangle
C) The femoral vein was transected at the at its junction with the saphenous vein
D) The medial circumflex femoral was severed at its origin
E) The deep femoral artery was divided at its origin

A

B) A vessel or vessels were injured at the apex of the femoral triangle

  • Medial is the key word here
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2
Q

What are the boundaries of the femoral triangle?

A

Base = inguinal ligament
Lateral wall = sartorius
Medial wall = adductor longus

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3
Q

What are the deep borders of the femoral triangle?

A

From lateral to medial = Iliacus, psoas major, pectinueus

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4
Q

What is the role of the femoral sheath?

A

It acts like a bursae because it helps the vessels slide under the inguinal ligament

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5
Q

What is contained in the femoral sheath from lateral to medial?

A 
Lateral = femoral artery 
Intermediate = femoral vein 
Medial = femoral canal
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6
Q

Where is the femoral nerve located in the femoral triangle?

A

Most lateral, next to iliacus but not in femoral sheath!

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7
Q

What is found most laterally within the femoral sheath?

A

Femoral artery

Not the nerve because it is not contained within the sheath

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8
Q

What is the opening to the femoral canal called?

A

Femoral ring

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9
Q

What does the femoral canal allow?

A

The femoral vein to expand during increased venous return

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10
Q

What does the femoral canal contain?

A

Few lymph vessels, loose CT and fat

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11
Q

What is a femoral hernia?

A

Occurs at femoral ring which is a weak area in the anterior abdominal wall where a loop of small intestine can protrude into the femoral canal

  • More common in women
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12
Q

What type of hernia is more common in men?

A

Inguinal hernia

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13
Q

What do inguinal LNs drain lymph from?

A
  • Lower limb, including gluteal region
  • Perineum and parts of anal canal
  • Anterior abdominal wall (up to umbilicus)
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14
Q

What are teh 2 groups of inguinal LNs?

A

1) Superficial inguinal LNs (proximal (horizontal) group and distal (vertical) group)
2) Deep inguinal LNs

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15
Q

What type of inguinal LNs cannot be palpated?

A

Deep inguinal LNs

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16
Q

What type of LNs are found along each side of teh great saphenous vein?

A

Distal (vertical) group of superficial inguinal LNs

  • Pass deep to inguinal ligament and drain into external iliac LNs
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17
Q

What LNs are found inferior to the inguinal ligament?

A

Proximal (horizontal) group of inguinal LNs

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18
Q

Where are deep inguinal LNs found?

A
  • 1-3 nodes along medial side of femoral vein
  • Inside femoral canal of femoral sheath
  • Drain into external iliac LNs
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19
Q

What is the largest branch of the lumbar plexus?

A

Femoral nerve

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20
Q

What spinal nerves converge to form the femoral nerve?

A

L2-L4

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21
Q

Where does the femoral nerve enter the thigh?

A

Just lateral to midpoint of inguinal ligament and lateral to femoral vessels

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22
Q

What muscles does the femoral nerve innervate?

A

Iliacus
Sartorius
Quadriceps femoris
Pectineus

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23
Q

What can occur is the lateral femoral cutaneous nerve is compressed?

A

Meralgia paresthetica

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24
Q

Due to limb rotations of the lower extremities, more lumbar contributions are visible ___________ and sacral ___________

A

Anteriorly; posteriorly

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25
Q

What 2 nerves may be affected by an anterior hip dislocation?

A

Femoral nerve

Lateral femoral cutaneous nerve

26
Q

What is the most common form of hip dislocation?

A

Posterior

27
Q

Meralgia paresthetica is caused by compression of lateral femoral cutaneous nerve as it passes under the inguinal ligament, where does this cause pain?

A

Along lateral thigh

28
Q

What does the saphenous nerve supply?

A

The skin of the anterior and medial knee and leg and the medial foot

29
Q

Which nerve becomes superficial between sartorius and gracilis?

A

Saphenous nerve

  • Passes anterolateral-inferiorly wiith great saphenous vein
30
Q

The saphenous nerve and saphenous branch of descending genicular artery exit through the _________ side of the canal

A

Medial

This is not the canals true exit! The actual exit of the canal is in the back of the knee

31
Q

Where does the adductor canal begin and end?

A

Begins at femoral triangle apex and ends at adductor hiatus

32
Q

What is the adductor hiatus?

A

Opening in tendon of adductor Magnus

33
Q

As the femoral artery and femoral vein exit the adductor canal, what do they become?

A

The popliteal artery and vein

34
Q

What is the chief arterial supply to the lower limb?

A

Femoral artery

35
Q

Inferiorly in the thigh, the femoral artery gives rise to descending genicular artery which consists of what 2 branches?

A

Articular branch

Saphenous branch

36
Q

What is the largest branch of the femoral artery?

A

Profunda femoris artery -> chief artery to thigh

37
Q

What provides the main blood supply to the femoral head and neck?

A

Medial circumflex femoral artery

38
Q

What branch of the femoral artery passes between the iliopsoas and pectineus to reach the posterior thigh, making up the lateral floor of the femoral triangle?

A

Medial circumflex femoral artery

39
Q

What branch of the femoral artery passes laterally, deep to the sartorius and rectus femoris?

A

Lateral circumflex femoral artery

40
Q

What branch of the femoral artery supplies the lateral thigh muscles and femur head?

A

Lateral circumflex femoral artery

41
Q

What branch of the femoral artery supplies the epiphysis?

A

Lateral circumflex femoral artery

42
Q

What branches of the femoral artery supply the diaphysis?

A

Deep femoral arteries

43
Q

What 2 things do deep perforating arteries of the femoral artery supply?

A

Adductors (particularly adductor Magnus) and hamstring muscles

44
Q

What vein in the leg can be used to administer blood, electrolytes, drugs etc?

A

Great saphenous vein

45
Q

What vein can be used for coronary bypass surgery?

A

Great saphenous vein

46
Q

A patient may complain of pain along medial border of foot as a result of a _____________ ______________

A

Saphenous cutdown (saphenous nerve)

47
Q

If a patient experiences numbness or pain along the medial boarder of the foot after a saphenous cutdown, what is likely the problem?

A

The saphenous nerve was cut when the physician cut the saphenous vein to directly administer fluids to the blood stream (electrolytes, drugs, blood, etc)

48
Q

What is a “hip pointer”?

A

A contusion of the iliac crest, usually where the arteries attaches at the ASIS

  • Usually occurs in contact sports
49
Q

Wha does a contusion lead to?

A

Bleeding from the capillaries and can form a hematoma, most commonly in the quadriceps region and is known as a “charley horse” and is usually is due to tearing of the fibers of the rectus femoris or even the quadriceps tendon itself

50
Q

What is the most common way for a psoas abcess to form?

A

From a pyogenic infection (pus-forming) in the retroperitoneal region which can be associated with TB or Crohn’s

51
Q

What can a psoas abcess be confused with and how can you confirm that it is a psoas abcess?

A

It is palpable and can be mistaken for an inguinal hernia or femoral hernia but you can order an abdominal X-ray and if the lateral border of the psoas is obscured (which it shouldn’t be) then it is probably a psoas abcess

52
Q

What would the gait of someone with a paralyzed quadricep look like?

A

They will typically press on the distal aspect of their thigh while walking to prevent inadvertent flexion at the knee

  • These pts also cant extend leg against resistance
53
Q

What type of fracture is common with rapid quadriceps flexion, such as catching yourself when falling backward?

A

Transverse fracture of the patella

  • Patellar fractures commonly result from a direct blow or trauma to the patella
54
Q

When does the patella develop into bone?

A

Patella beings as cartilage and develops into bone around age 3-6

55
Q

Abnormal ossification of the patella can occur during development and can be mistaken for a fracture, how can you prevent this mistake?

A

Abnormal ossification occurs bilaterally, so order an X-ray and examine the knee bilaterally, if it is a bilateral abnormality it is most likely abnormal ossification not a fracture

56
Q

What is a saphenous varix?

A

It is a local dilation of the great saphenous vein that can cause edema in the femoral triangle

57
Q

When should you consider that a patient may have a saphenous varix?

A

When a patient presents with varicose veins in the lower extremities

  • This can be confused with femoral/inguinal hernias and psoas abcesses
58
Q

When would you cannulate the femoral vein versus artery?

A

Cannulate the vein to reach the right atrium of the heart or pulmonary artery and use the artery for the left side of the heart

59
Q

What does the patellar reflex test?

A

Integrity of femoral nerve and L2-L4 spinal cord segments

  • Absence of patellar tendon reflex may result from any lesion that interrupts the innervation of the quads (peripheral nerve disease)
60
Q

What is the major groin pull muscle?

A

Adductor longus

61
Q

If the femoral artery, what anastomosis can provide blood supply to save the leg?

A

Cruciate anastomosis consisting of the transverse branch of the lateral circumflex femoral artery, transverse branch of the medial circumflex artery, inferior gluteal artery, 1st perforating artery of DFA

COM: MSK (Midterm) COPY (23 decks)

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