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Anatomy MRCEM part 1 > Lower limb > Flashcards

Lower limb Flashcards

1
Q

Surface anatomy for the sciatic nerve in the buttock?

A

Midway between greater trochanter and ischial tuberosity

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2
Q

What is the mid inguinal point?

SA for what?

A

Midway between anterior superior iliac spine and pubic symphysis

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3
Q

Structures medial to lateral in the popliteal fossa?

A

Popliteal artery
Popliteal vein
Tibial nerve
Common fibular nerve

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4
Q

Each nerve in the leg supplies…

  1. Lat. cuteaneous nerve
A
  1. Lateral thigh
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5
Q
  1. Obturator
A
  1. Medial thigh just below the groin
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6
Q
  1. Femoral nerve
A
  1. Middle of thigh and upper knee
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7
Q
  1. Posterior cuteaneous nerve of the thigh
A
  1. Posterior thigh and middle of popliteal fossa
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8
Q
  1. Saphenous nerve (branch of femoral)
A
  1. Medial lower knee, medial lower leg and medial arch of foot (not toes), posterior medial lower leg
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9
Q
  1. Common fibular nerve
A
  1. Lateral lower leg, dorsum of foot
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10
Q
  1. Tibial nerve
A
  1. Posterior lower leg in the middle, heel and lateral foot
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11
Q

Contents of anterior thigh compartment?

A

Quadriceps and sartorius

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12
Q

Contents of medial thigh compartment?

A

Adductors and obturator nerve

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13
Q

Posterior thigh compartment contents?

A

Hamstrings and sciatic nerve

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14
Q

Action and innervation of Psoas major?

A

Hip flexion

L1-3

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15
Q

Action and innervation of Ilacus?

A

Hip flexion
Femoral nerve

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16
Q

Why is the leg shorted and externally rotated in NOF?

A

Iliopsoas attach to lesser trochanter so shortens and externally rotates the LL

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17
Q

Action and innervation of sartorius?

A

Flexes the hip, laterally rotates and abducts the hip

Femoral nerve

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18
Q

Action and innervation of Quadriceps femoris?

A

Extend the knee

Femoral nerve

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19
Q

Action and innervation of 3 vasti muscles?

A

Extend the knee

Femoral nerve

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20
Q

Action and innervation of rectus femoris?

A

Flexes the hip and extends the knee

Femoral nerve

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21
Q

Where does the great saphenous vein start?

A

The great saphenous vein forms on the dorsum of the foot as the continuation of the medial marginal vein of the foot.
2.5cm anterior to the medial malleolus

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22
Q

Great saphenous vein course in relation to the tibia?

A

It then passes anteriorly to the medial malleolus to ascend at first medial to and then posterior to the medial aspect of the tibia.

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23
Q

Where does the great saphenous vein lie in the thigh?

A

Medial

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24
Q

Where does the great saphenous vein enter the femoral vein?

A

3.5cm below and lateral to the pubic tubercle

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25
Q

Course of the small saphenous vein foot to PF

A

Lateral foot then posterior thigh

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26
Q

What does the saphenous vein become?

A

Popliteal vein

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27
Q

Where do superficial leg lymph drain into?

A

Superficial inguinal nodes inferior to the inguinal ligament

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28
Q

Where do deep leg lymph drain into?

A

Deep inguinal nodes medial to the femoral vein

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29
Q

What does the femoral triangle extend as?

A

Adductor canal

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30
Q

Base of the femoral triangle

A

Inguinal ligamentt

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31
Q

Boundaries of the femoral triangle

Proximal
Medial
Lateral

A

Inguinal ligament

Medial border of adductor longus

Medial border of sartorius

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32
Q

What creates the floor of the femoral triangle?

A

Iliopsoas
Pectineus
Adductor longus

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33
Q

Femoral triangle contents

A

NAVLY

Lateral - > Medial

Femoral nerve
F Artery
F Vein
Lymph nodes (deep)

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34
Q

F. A / V & femoral canal surrounded by what?

A

Femoral sheath

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35
Q

What is transmitted in the femoral canal?

A

Lymphatics

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36
Q

Where do femoral hernias occur?

A

In the femoral canal (below the inguinal ligament)

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37
Q

Which nerves may become compressed near he inguinal ligament?

A

Lat. cutaenous nerve of the high

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38
Q

Femoral canal boundaries

Medial
Lateral
Ant.
Post.

A

Lacunar ligament
Femoral vein
Pictineus ligament
Inguinal ligament

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39
Q

Surface anatomy for the F. artery

A

Mid inguinal point

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40
Q

How for the femoral blood vessels enter the popliteal fossa?

A

Via the adductor hiatus (distal end of the the adductor canal)

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41
Q

Gluteus maximus

Action

Innervation

A

Extension of the hip and external rotator

Inferior gluteal

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42
Q

Gluteus minimus

Action

Innervation

A

Hip abduction and medial rotation

Superior gluteal nerve

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43
Q

Piriformis

Action

Innervation

A

Lateral rotation (+ abduction)

Piriformis nerve

44
Q

Which muscles are synergistic femoral lateral rotators and hip stabilisers:

A

piriformis, obturator internus and
quadratus femoris

45
Q

3 hamstrings muscles

A

Biceps femoris
Semitendinosus
Semimebranosus

46
Q

Biceps femoris

Action

Innervation

A

Knee flexion and lateral leg rotation

Sciatic nerve

47
Q

Semitendinosus

Action

Innervation

A

Knee flexion, extend hip, medially rotate hip and knee

Sciatic nerve

48
Q

Semimebranosus

Action

Innervation

A

Knee flexion, extend hip, medially rotate hip and knee

Sciatic nerve

49
Q

Which quadrant of the buttock does the sciatic nerve run through?

A

Inferior medial

50
Q

What causes a trendelenburg gai?

A

Weakness of the abductor muscles of the gluteal region (medius and minimus)

51
Q

Where does the extra capsular arterial ring of the hip joint sit?

A

Base of the femoral neck

52
Q

Gluteus medius

Action

Innervation

A

Abduction and medial rotation of the lower limb

Superior gluteal nerve

53
Q

Borders of the popliteal fossa

A

Medial proximal - Semi mem / tendon

Lateral proximal - bicepsfemoris

Medial / lateral distal - heads of gastrocnemius

54
Q

Deepest structure in the popliteal fossa?

A

Popliteal artery

55
Q

4 contents of popliteal fossa

A

Popliteal artery
Popliteal vein
Tibial nerve
Common fibular nerve (common peroneal nerve)

56
Q

Where does the small saphenous vein drain into the popliteal vein?

A

The small saphenous vein pierces the popliteal fascia and passes between the two heads of gastrocnemius to empty into the popliteal vein.

57
Q

Why is the medial meniscus vulnerable to injury?

A

It’s anchored to the patella capsule

58
Q

What muscle plays a key role in ‘unlocking the knee’

A

The popliteus muscle may play a role in initiating unlocking of the knee because it reverses the direction of automatic external rotation that occurs in the final stages of knee extension

59
Q

Where can the common fibular nerve be damage ?

A

When knee struck from a lateral aspect in the extended position

60
Q

Roles of the menisci

A

To deepen the articular surface of the tibia, thus increasing stability of the joint.

To act as shock absorbers by increasing surface area to further dissipate forces.

61
Q

Which bursa is an extension of the synovial cavity of the knee

A

Suprapatellar bursa

62
Q

Unhappy Triad (Blown Knee) - what is damaged?

A

A lateral force to an extended knee, such as a rugby tackle, can rupture the medial collateral ligament, damaging the medial meniscus in the process. The ACL is also affected, which completes the ‘unhappy triad’.

63
Q

Soleus

Action

Innervation

A

Actions: Plantarflexion of the foot at the ankle joint.

Tibial nerve

64
Q

Gastrocnemius

Action

Innervation

A

Actions: Plantarflexion at the ankle joint and flexion at the knee joint.

Innervation: Tibial nerve.

65
Q

Plantaris

Action

Innervation

A

Actions: Contributes to plantarflexion at the ankle joint and flexion at the knee joint.

Innervation: Tibial nerve.

66
Q

What bone does the achilles tendon attach to distally

A

Posterior calcaneus

67
Q

Most powerful of the deep flexors

A

Flexor hallucis longus

68
Q

Flexor hallucis longus

Action

Innervation

A

Flexes great toe
Inversion of the ankle
Maintains the medial longitudinal arch

Innervation: Tibial nerve

69
Q

Flexor Digitorum Longus

Action

Innervation

A

Actions: Flexion of the lateral four toes.
Innervation: Tibial nerve

70
Q

Tibialis Posterior

Action

Innervation

A

Actions: Inversion and plantarflexion of the foot. It also contributes to the medial arch of the foot.

Innervation: Tibial nerve

71
Q

Ant. -> Posteror

Ligaments in the tarsal tunnel (medial foot)

A

Tibilais posterior (Tom)
Flexor digitorum longus (Dick)
Flexor hallucis longus (Harry)

72
Q

Ant. - Posterior

All contents of the tarsal tunnel

A

Tibilais posterior (Tom)
Flexor digitorum longus (Dick)
Posterior tibial artery
Tibial vein (Very)
Tibial nerve (Naughty)
Flexor hallucis longus (Harry)

73
Q

Fibular artery is a branch of?

A

Posterior tibial artery

74
Q

What does the anterior tibial artery become?

A

Dorsalis pedis

75
Q

Tibialis anterior

Action

Innervation

A

Dorsiflex and inversion of the foot

Deep fibular

76
Q

Extensor hallucis longus

Action

Innervation

A

Extend big toe
Dorsiflex

Deep fibular

77
Q

Extensor digitorium

Action

Innervation

A

Dorsiflexion
Extend 4 toes

Deep fibular

78
Q

Fibularis tertius

Action

Innervation

A

Assist dorsiflexion and eversion

Deep fibular

79
Q

Where is the common fibular nerve commonly damaged

Presentation

A

Close to neck of femur

Impaired dorsiflexion (high stepping gait)

80
Q

Fibularis brevis

Action

Innervation

A

Plantar flex and eversion

Superficial fibular

81
Q

Fibularis longus

Action

Innervation

A

Plantar flexion
Eversion

Superficial fibular (peroneal) nerve

82
Q

Two retinaculum of the foot

A

Extensor - anteriorly

Peroneal - lateral)

83
Q

Intrinsic muscles of the foot

A

There are two intrinsic muscles located within the dorsum of the foot – the extensor digitorum brevis and extensor hallucis brevis.

84
Q

Proximal group of tarsal bones

A

Talus, calcaneus

85
Q

Intermediate tarsal bone

A

Navicular

86
Q

Distal tarsal bones

A

Cuboid & cuneiforms (3)

87
Q

Medial collateral ligament of the ankle is also called?

A

Deltoid ligament

88
Q

4 bands of the deltoid ligament

A

Tibioavicular

Tibiotalar x 2

Tibiocalcaneal

89
Q

3 lateral collateral ligaments

A

Anterior talofibular
Posterior “”
Calcaneofibular

90
Q

What bones form the medial longitudinal arch

A

Talus
Calcaneus
Navicular
3 cuneiforms
Medial metatarsals

91
Q

What bones form the lateral longitudinal arch

A

Calcaneus, cuboid, 2 lateral metatarsals

92
Q

What bones form the transverse arch

A

3 cuneiforms, cuboid and bases of 3 metatarsals

93
Q

Deepest layer of the sole, 3 muscle groups

A

Abductor hallucis
Flexor digitorum brevis
Abductor digiti minimi

94
Q

Medial and lateral plantar nerves are the terminal branches of ?

A

Tibial nerve

95
Q

Which layer of the foot do the long flexor tendons lie?

A

2nd

96
Q

In which layer of the sole does the NV plane lie?

A

Neurovascular plane lies
between the first and second layers

97
Q

Which tendons lie in the 4th layer of the foot?

A

Tendons of tibialis posterior and peroneus longus are part of the fourth.

98
Q

Insertion in the foot of fibularis longus?

A

The tendon crosses under the foot, and attaches to the bones on the medial side, namely the medial cuneiform and base of the 1st metatarsal.

99
Q

Insertion in the foot of tibialis posterior?

A

The tendon enters the foot posterior to the medial malleolus and attaches to the plantar surfaces of the medial tarsal bones.

100
Q

Femoral nerve damage presentation

A

Poor flexion of the hip

Inability to extend the knee

Sensory decline over the anterior and medial aspects of the thigh

Sensory loss on the medial side of the leg and foot up to the ball of the great toe

101
Q

Obturator nerve damage presentation

A

Loss of hip adduction
Loss of sensation medial thigh

102
Q

Damage to the Tibial Nerve presentation

A

Damage to the tibial nerve is rare, and is often a result of direct trauma, entrapment through narrow space or compression for long period of time. Damage results in loss of plantar flexion, loss of flexion of toes and weakened inversion (The tibialis anterior can still invert the foot).

103
Q

Fibular nerve most commonly damaged by…

A

The common fibular nerve is most commonly damaged by a fracture of the fibula, or the use of a tight plaster cast.

104
Q

Damage to common fibular nerve presentation

A

Patients with common fibular nerve damage will lose the ability to dorsiflex the foot at the ankle joint. Hence the foot will appear permanently plantarflexed – known as footdrop.

Loss of sensation over the dorsum of the foot, and lateral side of the leg.

105
Q

All muscles below the knee supplied by which nerve?

A

Sciatic nerve ( branches of)

Anatomy MRCEM part 1 (7 decks)

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