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GSSE > Lower limb > Flashcards

Lower limb Flashcards

1
Q

12713 – At the hip joint
1: the obturator internus produces lateral rotation
2: the gluteus medius produces abduction
3: the gluteus minimus produces medial rotation
4: the obturator externus produces medial rotation

A

TTTF
Any muscle passing obliquely or transversely across the back of the hip joint and behind the vertical axis around which the femoral head rotates must act as a lateral rotator of the extended thigh.
Gluteus maximus is the most powerful lateral rotator. The others are more active as stabilisers of the hip joint but obturator internus together with the gluteus medius, piriformis, gemelli, obturator externus and quadratus femoris are lateral rotators (A true). Any muscle whose line of pull passes across the front of the hip joint and thus anterior to the vertical axis around which the femoral head rotates must act as a medial rotator of the extended thigh. The anterior portions of both gluteus minimus (C true) and gluteus medius can thus act as medial rotators as do the psoas major and illiacus. The obturator externus passes behind the hip joint, and although mainly a stabiliser of the hip joint, is therefore also a lateral rotator of the extended thigh (D false). Abduction is produced by the gluteus medius and gluteus minimus (B true).

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2
Q

22018 – The gluteus maximus muscle
1: is attached to the intertrochanteric line of the femur
2: is attached to the iliotibial tract
3: is supplied by fibres from L4, L5 and S1
4: is an extensor of the trunk on the lower limb

A

FTFT
Last PAGE: 145, 146
Gluteus maximus
Arises: outer surface of ilium behind posterior gluteal line, and posterior third of iliac crest, lumbar fascia, lateral mass of sacrum, sacrotuberous ligament, and coccyx.
inerts: Deeperst quarter into gluteal tuberosity of femur, remaining 3/4 into the iliotibial tract (anterior surface of lateral condyle of tibia.
Action: extends and latearlly rotates hip. Maintains knee extended via iliotibial tract
Nerve: inferior gluteal L5,S1,S2
Largest muscle in the body

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3
Q

19198 – The superior gluteal nerve
A. has a cutaneous distribution to the skin of the buttock
B. gives off deep and superficial branches
C. supplies the tensor fascia lata
D. supplies the gluteus maximus
E. contains fibres from the second sacral spinal segment

A

C
Last 8th ed. PAGE: 164, 399
L4, L5, S1.
Passes above piriformis through greater sciatic foramen

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4
Q

19312 – The ossification centre of the femoral head appears
A. at the eighth week of foetal life
B. by the sixth post-natal week
C. in the first year of life
D. at 2 years of age
E. at 3 years of age

A

C
Last 8th ed. PAGE: 224

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5
Q

23474 – The femoral canal
1: at its proximal end is medial to the femoral vein
2: contains the femoral branch of the genitofemoral nerve
3: at its proximal end is posterior to the inguinal ligament
4: is the lateral compartment of the femoral sheath

A

TFTF
Last PAGE: 138
NAV - space
Femoral branch of genitofemoral nerve is in the femoral triangle but not in canal
all of it is posterior to inguinal ligament,
it is medial in the femoral sheath

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5
Q

21193 – The femoral triangle
1: has a floor formed by the iliacus muscle, the psoas major tendon, the pectineus muscle and the adductor longus muscle
2: is bounded below and medially by the adductor brevis muscle
3: is roofed over by the fascia lata of the thigh
4: contains the obturator nerve

A

TFTF
Last 8th ed. PAGE: 152-4.
Boundaries:
- inguingal ligamnet,
- Medial: medial border of adductor longus
- lateral: medial border of sartorius
- floor - pectineus and adductor longus medially, psoas major and iliacus latearlly

contents of the femoral triangle
N
- Lateral cutaneous nerve of the thigh.
- nerve to pectineus arising from the femoral nerve just above inguinal ligament. passes behind the femoral sheath
- Femoral nerve
Femoral sheath:
- NAVEL
Femoral branch of the genitofemoral n, femoral nerve , artery, vein, empty space, lymphatics - deep inguingal lymph nodes - drains the clitoris or glands penis.

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6
Q

7834 – The femoral vein in the femoral triangle
1: is medial to the femoral artery
2: is lateral to the femoral canal
3: directly receives the great (long) saphenous vein
4: directly receives the profunda femoris vein

A

TTTT
Last 10th ed, Ch 3

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7
Q

22529 – Boundaries of the femoral ring include
1: inguinal ligament
2: femoral vein
3: lacunar ligament
4: pectineal ligament

A

TTTT
Last PAGE: 138
The superior opening of the femoral canal under the inguinal ligament is termed the femoral ring

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8
Q

946 – In femoral hernia, the hernial sac
1: passes behind the inguinal ligament.
2: Passes medial to the femoral vein.
3: Passes anterior to the superior pubic ramus.
4: Is covered by the fascias of the femoral septum and the cribriform fascia.
5: Contains a large quantity of fat.

A

TTTTT
The sac of a femoral hernia passes behind the inguinal ligament (1 true) into the femoral canal, which lies medial to the femoral vein and anterior to the superior pubic ramus. (2 & 3 true). The sac enters the femoral canal through its upper opening -the femoral ring. This is normally closed by the femoral septum, a fusion of iliopectineal fascia behind and transversalis fascia anteriorly. The sac, covered by intraperitoneal fat and femoral septum fascia, leaves the femoral canal to enter the subcutaneous tissues of thigh and groin,
by passing anteriorly through the fossa ovalis and its overlying cribriform fascia. (4 true). The sac of a femoral hernia thus contains several fascial layers separated from each other by fat. A large portion of the sac is fatty (5 true) which can make the cough impulse of a femoral hernia less obvious.

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9
Q

21033 – S. A femoral hernia can present deep to the membranous layer of superficial fascia of the abdominal wall (scarpa’s fascia) BECAUSE R. Scarpa’s fascia inserts into the deep surface of the inguinal ligament

A

both S and R and false
Last Page: 133

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10
Q

934 – Femoral hernia is
1: More common in female than in male patients.
2: More common than inguinal hernia in female patients.
3: Able to be controlled by the wearing of a hernia truss.
4: Classically associated with strangulation bowel obstruction of Richter type.
5: More prone to recurrence after surgery than is inguinal hernia.

A

TFFTF
Femoral hernia is more common in females than in males (1 true). You would need to go back further to find the records of 100 femoral hernia repairs, because femoral hernias are much less common than are inguinal hernias. But there would be a majority of females in your group. The femoral ring and canal are wider in females than males, in keeping with the wider female pelvis.
Inguinal hernias outnumber femoral in women as well as in men (2 false). Thus if you identify a groin hernia and you cannot be sure of the clinical diagnosis in a male, the odds on it being inguinal are quite high. In a woman under the same circumstances the hernia is also more likely to be inguinal, but the odds will not be so great. For most hernias, a truss is not a reliable method of control. The hernia must be reducible and the truss needs to control the defect and prevent the hernia escaping. If the hernia does protrude while a truss is worn, the effectiveness of the truss is lost and the risk of
strangulation increased. A truss might be occasionally helpful in an infirm patient when the mouth of the hernial sac is wide, the hernia is easily reducible and the risk of strangulation considered low.
Femoral hernias have a small neck and a tortuous sac pathway and are particularly unsuited to truss use (3 false). Response 4 is true and 5 false (see X1).

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11
Q

7759 – Division of the lumbo-sacral trunk would cause
1: loss of skin sensibility in the great toe
2: weakness of peroneus longus
3: weakness of extensor hallucis longus
4: weakness of abductor hallucis

A

TTTF
Last 10th ed, Ch 1 and Ch 5.
Lumbosacral trunk = anterior segment of 4th and 5th lumbar nerves. Forms the sciatic nerve. Would cause weakness in fibular (peroneal) nerve.
Abductor hallucis - innervated by medial plantar nerve, branch of tibial n (L5, S1) hence not affected

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12
Q

19617 – The ventral primary ramus of S1
A. contributes to the pudendal nerve
B. is distributed to skin on the back of the thigh
C. is distributed to flexors of the hip
D. is distributed to evertors of the foot
E. contributes to the lumbo-sacral trunk

A

D
Last PAGE: 29

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13
Q

21883 – The sacral plexus
1: supplies obturator externus muscle
2: is formed by ventral rami of L4, L5, S1, S2,S3 and S4 spinal nerves
3: receives the lumbosacral trunk
4: lies in front of the piriformis muscle

A

FTTT
Last (8) PAGE: 160, 416

Obturator externus is supplies by posterior division of obturator nerve L3,4

Sacral plexus lies on piriformis
L4,5, S1,2,3,4 from lumbosacral trunk L4, 5 and anterior primary rami from S1-4 to definitve nerves

All six branches leaving sacral roots begin with p

Piriformis (nerve to) S1,2
Posterior femoral cutaneous
- S1,2,3 , exits greater sciatic foramen
Perforating cutaneous
- S2,3 exits greater sciatic foramen
Pudendal
- S2,3,4 exits lessor sciatic foramen
pelvic splanchnic
- S2,3,4 (parasympathetic)
Perineal branch of S4
- Supplies levator ani

Others are superior and inferior gluteal which are both L4,5,S1

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14
Q

23134 – The femoral nerve
1: supplies skin on the medial side of the leg
2: enters the thigh anterior to the iliopsoas fascia
3: supplies the psoas major muscle
4: supplies the pectineus muscle

A

TFFT
Last PAGE: 139, 165
1: Anterior femoral cutaneous does most of the medial distal thigh and saphenous nerve (branch of femoral) does medial leg?
2: lies in the groove between psoas and iliacus /lies on the iliacus
3: psoas major is supplied by anterior primary rami of L1,2

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15
Q

2324 – The femoral nerve
1: is formed in the substance of psoas major
2: emerges on the lateral side of the psoas muscle
3: lies on the iliacus muscle beneath the inguinal ligament
4: is formed from the posterior divisions of the ventral rami of L 2, 3, 4

A

TTTT
Last (8) PAGE: 362

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16
Q

13956 – The femoral nerve is most likely to
A. arise from the anterior divisions of the ventral rami of L2, L3, L4
B. supply the gracilis muscle
C. lie medial to the femoral artery under the inguinal ligament
D. supply sensation to skin on the medial malleolus
E. supply sensation to the skin over the central border of the foot via the sural nerve

A

D
Refer to Last, 10th Ed, page 157

A - posterior divisions of ventral rami (ant div = obturator n)
B - Gracilis is supplied by anterior division of obturator n L2,3
C - lies lateral to femoral artery (NAVY!)
D - via saphenous nerve

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17
Q

12718 – The femoral nerve supplies the
1: pectineus
2: tensor fasciae latae
3: psoas major
4: gracilis

A

TFFF
The femoral nerve in the thigh branches into superficial and deep branches and supplies pectineus (A true), sartorius, rectus femoris and the vasti.
The gracilis is supplied by the obturator nerve as are the adductors (D false). Psoas is supplied segmentally from the lumbar plexus L1,2 (C false). Tensor fasciae latae is supplied by the superior gluteal nerve which ends in it (L4,5) (B false).

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18
Q

20199 – S. The femoral nerve remains outside the femoral sheath BECAUSE R. the femoral nerve lies behind the fascia iliaca

A

S is true, R is true and a valid explanation of S
Last PAGE: 138

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19
Q

20307 – S. The femoral nerve supplies muscles in the extensor compartment of the thigh BECAUSE R. the femoral nerve is derived from
posterior divisions of anterior primary rami

A

S is true, R is true and a valid explanation of S
Last 8th ed. PAGE: 156

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20
Q

24109 – The sciatic nerve
1: gives a branch to adductor magnus
2: supplies extensors of the hip
3: supplies flexors of the knee
4: supplies skin on the posterior aspect of the thigh

A

TTTF
Last PAGE: 153, 154
4 - posterior femoral curaneous nerve of the thigh (nerve from sacral plexus)

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21
Q

21333 – The sciatic nerve
1: supplies all three hamstrings and ischial fibres of adductor magnus
2: is a direct posterior relation of the hip capsule
3: supplies quadratus femoris and obturator internus
4: is supplied with blood by a branch of the inferior gluteal artery

A

TFFT
Last 8th ed. PAGE: 167, 418
3 - quad fem supplied by nerve to quadratus femoris (L5, S1), obturator internus supplied by nerve to obturator internus (L5, S1,2)

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22
Q

19683 – Division of the sciatic nerve would result in loss of sensation
A. on all of the thigh, leg and foot
B. on the back of the thigh and calf, and on the sole of the foot
C. on all of the leg and foot
D. on the lateral side of the calf and most of the foot
E. over most of the sole of the foot alone

A

D
Last PAGE: 154
Ant thigh - femoral
post thigh - post femoral cutaneous
medial leg - saphenous n

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23
Q

19018 – As it passes down the thigh, the sciatic nerve is crossed superficially from medial to lateral by
A. adductor magnus
B. long head of biceps femoris
C. semimembranosus
D. quadratus femoris
E. short head of biceps femoris

A

B
Last PAGE: 154

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24
Q

14132 – With respect to the nerve supply of the lower limb
1: all interosseous muscles of the foot are supplied by the medial plantar nerve
2: the weight bearing area of the heel is supplied by the medial calcaneal nerve
3: extension of the knee is associated with spinal segments L4/5
4: sensation in the groin is associated with spinal segment L1

A

FTFT
Refer to Last, 10th Ed, page 13-17, 148-149
1 - one interossei (first ?) supplied by lateral plantar)
2.-
3 knee ext L3/4
4 - sensation in groin L1

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25
Q

19252 – Which of the following muscles does not arise from the ischial tuberosity?
A. semimembranosus
B. adductor magnus
C. obturator externus
D. long head of biceps femoris
E. semitendinosus

A

C
Last PAGE: 143, 152
All of hamstring arise from ischial tuberosity!

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26
Q

20337 – S. Fracture of the femoral neck proximal to the capsular attachment may cause aseptic necrosis BECAUSE R. the head and neck of the femur receive their blood supply mainly through the subcapsular retinacular arteries

A

S is true, R is true and a valid explanation of S
Last 8th ed. PAGE: 167

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27
Q

14957 – The deep fascia of the thigh
1: receives the insertion of the whole of the tensor fasciae latae muscle
2: splits to enclose the gluteus maximus muscle
3: is attached to the inguinal ligament
4: receives the insertion of the whole of the gluteus maximus muscle

A

TTTF
Refer to Last, 10th Ed, page 111-112
deepest quarter into gluteal tuberosity, remaining three quarters into iliotibial tract ( anterior surface of lateral condyle of tibia). only receives 3/4 of it.

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28
Q

21188 – The femoral artery
1: is deep to the adductor brevis muscle
2: lies anterior to the tendon of psoas major
3: gives only a profunda branch in the femoral triangle
4: is posterior to the femoral vein in the upper part of the adductor (subsartorial) canal

A

FTFF
Last 8th ed. PAGE: 154-5
Lies on the tendon of psoas major and is separated from pectineus and adductor longus by femoral vein,
femoral vein begins to lie progressively more posterior to the artery within the femoral triangle. as it enters the adductor canal it lies on the adductor longus and then magnus.
saphernous nerve passes anteriorally from lateral to medially.

Adductor canal
- groove in anterior thigh extending from apex of femoral triangle to hiatus in adductor magnus
- borders
lateral - vastus med; med - add long superiorly and add mag inferiorly. roof = sartorius and subsartorial plexus.

in popliteal fossa popliteal artery is deepest structure

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29
Q

22864 – The cruciate anastomosis is formed from
1: the transverse branch of the medial circumflex artery
2: the descending branch of the inferior gluteal artery
3: the ascending branch of the first perforating artery
4: the ascending branch of the lateral circumflex artery

A

TTTF
Last 8th ed. PAGE: 166

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30
Q

19192 – The pectineus muscle
A. is covered on its deep surface by the fascia lata
B. is inserted along the spiral line of the femur
C. lies anterior to the anterior division of the obturator nerve
D. is attached to the pubic tubercle
E. is supplied by the posterior division of the femoral nerve

A

C
Last 8th ed. PAGE: 154
arises - pectineal line of pubis and area of sup pub ramus
inserts - vertical line between spiral line and gluteal crest below lesser trochanter
action - flexes and adduct hip
nerve - ant div of femoral (not post). occ twig from obturator.
relations
- posterior is adductor magnus, brevis and obturator externus. and anterior branch of obturator nerve.

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31
Q

22259 – At the distal end of the femur
1: the popliteus muscle is attached to the anterior end of a groove on the lateral condyle of the femur
2: the lateral condyle projects further forwards than the medial condyle
3: the anterior cruciate ligament is attached to the lateral condyle
4: growth stops before the cessation of growth at the proximal end

A

TTTF
Last (Page 157,200) Green Book (K2, K3)

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32
Q

20703 – S. The short head of biceps femoris is supplied from segments L5 and S1 BECAUSE R. the short head of biceps femoris is supplied by the tibial division of the sciatic nerve

A

S is true and R is false
Last 8th ed. PAGE: 170
Long head supplied by tibial sciatic
short head supplied by common fibular portion of sciatic (both L5,S1,2)

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33
Q

7664 – The adductor muscles of the thigh are arranged anteroposteriorly in
the order
A. longus, magnus, brevis
B. brevis, longus, magnus
C. longus, brevis, magnus
D. brevis, magnus, longus
E. none of the above

A

C
Last 10th ed, Ch 3

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34
Q

20805 – S. The adductor magnus is partly supplied by the peroneal component of the sciatic nerve BECAUSE R. the adductor magnus is a composite of adductor and hamstring muscles

A

S is false and R is true
Last 8th ed. PAGE: 159-60
Supplied by tibial portion of sciatic nerve

35
Q

12728 – The adductor brevis
1: arises from the superior pubic ramus
2: is supplied by both the femoral and obturator nerves
3: has the femoral nerve directly in front of it
4: lies deep to the pectineus

A

FFFT
Adductor brevis constitutes the middle layer of the adductor group, deep to pectineus (D true) and adductor longus, which arise from the superior pubic ramus and body of the pubis below the crest.
Lying deep to them, adductor brevis arises from the inferior pubic ramus (A false). The obturator
nerve splits to lie in front of and behind adductor brevis, and is its sole supply (B false). The adductor muscle with a double nerve supply is adductor magnus. The femoral nerve, which supplies pectineus alone of the adductor group, lies lateral to the femoral sheath, and this is well separated from adductor brevis (C false).

adductor muscle layers:
1. superficial:
- pectineus, longus, gracilis
2. middle: adductor brevis
3. Deep: adductor magnus

Arises - inferior ramus and body of pubis
inserts - upper third of linea aspera
action - adducts hip
nerve - anterior division of obturator n

relations- anterior - adductor longus
posteiror - adductor magnus.
superior - obturator externus and medial circumflex femoral artery
Middle perforating artery pierces the muscle

36
Q

22624 – The adductor brevis
1: arises from the superior pubic ramus deep to pectineus
2: is supplied both by the femoral and obturator nerves
3: has the femoral nerve as a direct anterior relation
4: lies in front of the posterior division of the obturator nerve

A

FFFT
Last’s 10th Ed., p160.

adductor muscle layers:
1. superficial:
- pectineus, longus, gracilis
2. middle: adductor brevis
3. Deep: adductor magnus

Arises - inferior ramus and body of pubis
inserts - upper third of linea aspera
action - adducts hip
nerve - anterior division of obturator n

relations- anterior - adductor longus
posteiror - adductor magnus.
superior - obturator externus and medial circumflex femoral artery

37
Q

19024 – The semimembranosus muscle
A. produces lateral rotation of tibia upon femur
B. helps to limit flexion at the hip when the knee is extended
C. has two heads of origin
D. is supplied by the common peroneal division of the sciatic nerve
E. crosses superficial to the sciatic nerve in the upper part of the thigh

A

B
Last PAGE: 152-154

38
Q

24104 – Important abductors of the hip joint include
1: gluteus maximus
2: gluteus medius
3: piriformis
4: gluteus minimus

A

FTFT
Last PAGE: 151

39
Q

22269 – With regard to the quadriceps femoris muscle
1: the rectus femoris has one attachment to the pelvis
2: the vastus lateralis has fleshy fibres extending more distally than those of the vastus medialis
3: its nerve supply comes from the lumbar and sacral spinal nerves
4: the lowermost fibres of the vastus medialis are nearly vertical

A

FFFF
Last PAGE: 140
Rectus femoris:
- straight head arises ant inf iliac spine, reflected head ilium above acetabulum
L234 (no sacral components)
4 - no they are oblique - more horiztonal

40
Q

21203 – Muscles which may be innervated by more than one nerve include
1: obturator externus
2: pectineus
3: semimembranosus
4: adductor magnus

A

FTFT
Last 8th ed. PAGE: 154, 159

41
Q

12572, 20985 – S:The hamstring muscles are used only in strong extension of the thigh at the hip, but not as extensors in normal walking because R: the gluteus maximus muscle is used for extension of the hip
joint in normal walking

A

Last PAGE: 146, 154. The hamstring muscles cross two joints and are the main extensors of the
thigh at the hip, and flexors of the leg at the knee, especially during walking (S false). Gluteus maximus is not used for extension of the hip joint in normal walking, remaining lax in this activity (R false). Gluteus maximus is important at the extremes of hip extension; eg in climbing stairs, running.

42
Q

22474 – The adductor (subsartorial) canal
1: contains the nerve to the vastus medialis muscle
2: contains the saphenous nerve
3: is bounded laterally by the vastus lateralis muscle
4: contains the profunda femoris vessels

A

TTFF
Last PAGE: 157-8

Adductor canal
- extending from apex of femoral triangle to adductor hiatus in adductor magnus
- border
Lateral: Vastus medialis
Medial: Adductor longus and adductor magnus (superiorly and inferiorly)
Roof: sartorius , fascia, subsartorial plexus.
Contents
- Femoral artery, vein, saphenous nerve, nerve to VMO

43
Q

22023 – The boundaries of the adductor canal include the
1: sartorius and the subsartorial fascia
2: adductor magnus
3: vastus medialis
4: adductor longus

A

TTTT
Last 8th ed. PAGE: 157-8
Adductor canal
- extending from apex of femoral triangle to adductor hiatus in adductor magnus
- border
Lateral: Vastus medialis
Medial: Adductor longus and adductor magnus (superiorly and inferiorly)
Roof: sartorius , fascia, subsartorial plexus.
Contents
- Femoral artery, vein, saphenous nerve, nerve to VMO

44
Q

14127 – At the knee joint
1: lateral rotation of the femur at the beginning of flexion of the leg on the thigh is produced by popliteus
2: active rotation of the leg on the thigh is possible when the leg is flexed to ninety degrees
3: the suprapatellar bursa communicates with the cavity of the joint
4: the medial meniscus is attached along its peripheral border to the deep portion of the tibial collateral ligament

A

TTTT
Refer to Last, 10th Ed, page 130-135

45
Q

15307 – At the knee joint
1: the lateral and medial collateral ligaments contribute to the limitation of rotatory movements of the thigh on the leg
2: quadriceps power is increased by hip extension
3: the cruciate ligaments prevent backward and forward gliding of the femur on the tibia
4: the semimembranosus muscle can rotate the leg medially on the thigh

A

TTTT
Refer to Last, 10th Ed, Ch 3, page 130 and following

46
Q

21363 – The synovial membrane of the knee
1: may communicate with a bursa under the medial head of gastrocnemius
2: is reflected over the front of the anterior cruciate ligament
3: is reflected as a bursa beneath the tendon of popliteus
4: connects with a prepatellar bursa

A

TTTF
Last 8th ed. PAGE: 182
prepatellar burse - infront of patella - too superficial

47
Q

8515 – The patella
1: is not ossified at birth
2: is prevented from lateral displacement by the greater prominence of the lateral femoral condyle
3: gives attachment to fibres of the vastus medialis
4: has a larger medial articular surface as compared with its lateral articular surface

A

TTTF
Last 10th ed, Ch 3
Underside of patella has LL (Larger Lateral) surface

48
Q

18868 – Which of the following bursae normally communicates with the knee joint
A. the popliteus bursa
B. the bursa under lateral head of gastrocnemius
C. the prepatellar bursa
D. the superficial infrapatellar bursa
E. the bursa anserine

A

A
Last’s 9th Ed., p182.

49
Q

23819 – The anterior cruciate ligament of the knee
1: limits extension of the lateral condyle of the femur
2: is the primary restraint of posterior displacement of tibia upon femur
3: is extrasynovial
4: arises from the anterior tibial spine

A

TFTF
Manual PAGE: P.K4
ACL arises deep within the notch of distal femur - lateral condyle, inserts intercondyloid eminence of the tibia and blends with the medial meniscus

PCL arises from anterolateral edge of the medial femoral condyle and inserts on the posterior horn of lateral menscus

50
Q

18946 – The anterior cruciate ligament
A. passes upwards, backwards and laterally from the tibial eminence
B. lies anteromedial to the posterior cruciate ligament
C. limits external rotation by winding around the posterior cruciate ligament
D. prevents the femur from slipping forward off the tibial plateau
E. lies within the synovial cavity

A

A
Last 8th ed. PAGE: 181
ACL limits internal rotation
prevents anterior slipping of tibia

ACL arises deep within the notch of distal femur - lateral condyle, inserts intercondyloid eminence of the tibia and blends with the medial meniscus

PCL arises from anterolateral edge of the medial femoral condyle and inserts on the posterior horn of lateral menscus

51
Q

23739, 25447 – The semilunar cartilages of the knee
1: function in load absorption
2: contribute to stability of the joint
3: move passively during flexion and extension of the knee
4: are vascular close to their peripheral attachments

A

TTTT
Last PAGE: 184

52
Q

20613 – S. The knee joint is locked in full extension BECAUSE R. the ligaments of the knee are tightened by medial rotation of the tibia on the
femur

A

S is true and R is false
Last PAGE: 183
Tibia rotates laterally in screw home (to lock the knee); femur rotates medially in screw home because medial condyl of femur is longer than lateral

53
Q

12452, 19168 – The lateral meniscus of the knee
A. is attached to the fibular collateral ligament
B. gives part origin to the popliteus muscle
C. is attached to the anterior cruciate ligament by an extension of the attachment of the anterior hor
D. is larger than the medial meniscus
E. is totally devoid of vascular supply

A

B
Green Book PAGE: K5, 6.
The fibular collateral ligament is extracapsular, running from lateral condyle of femur to fibular head (A false). The lateral meniscus has an attachment to the tendon of popliteus (B true), but not to the anterior cruciate ligament (C false). The medial meniscus is rather larger than the lateral (D false): both menisci are vascularised at their outer margins (E false).

54
Q

19605 – The popliteus
A. arises by tendon from the soleal line
B. is supplied by the deep peroneal nerve
C. is an extensor of the knee joint
D. rotates the femur laterally on the tibia
E. has a bursa lying superficial to its tendon

A

D
Last PAGE: 151, 158
Arises - posterior shaft of tibia ABOVE the soleal line and below tibial condyles
Inserts - a facet on the lateral surface of lateral condyle of femur posterior-inferior to epicondyle.
Tendon passes into capsule of knee and a few fibres attach to lateral meniscus
Action - unlocks the extended knee by lateral rotation of the femur on the tibia (undo screw home) pulls back lateral meniscus
Nerve - tibial nerve L4,5,S1
Popliteus bursa lies deep to tendon and communicates with knee joint

55
Q

22479 – The popliteal artery
1: is anterior to the popliteal vein
2: is anterior to the tibial (medial popliteal) nerve
3: is anterior to the popliteus muscle
4: divides into the anterior and posterior tibial arteries

A

TTFT
Last PAGE: 156
Artery (deep, most anterior),
Vein
Nerve
Artery runs posterior to popliteus muscle

56
Q

21543 – With respect to the venous drainage of the lower limb
1: the saphenous nerve is closely associated with the long saphenous vein in the leg
2: the long saphenous vein does not provide the principal drainage of the medial side of the leg between the tibia and tendo calcaneus
3: the femoral vein is posterior to the femoral artery at the lower angle of the femoral triangle
4: the soleus muscle contains a rich plexus of veins

A

TTTT
Last PAGE: 132, 139, 165, 172
1
2 - ?deep veins e.g. posteiror / anterior tibial veins?
3 - Vein runs posterior to artery in the subsartorial canal

57
Q

7764 – With regard to the tibia
1: the flexor hallucis longus muscle is attached to its posterior surface
2: growth occurs principally at its upper end
3: the superior and inferior tibio-fibular joints are both synovial
4: there may be a separate epiphysis for the tuberosity

A

FTFT
Last 10th ed, p168.
1 - Flexor hallucis - arises posterior fibula and interosseus membrane
3 - superior tibiofibular is plane synovial and inteferior tibiofibular is a fibrous joint (syndesmosis )

58
Q

19282 – Flexor digitorum longus
A. crosses deep to tibialis posterior in the calf
B. crosses deep to flexor hallucis longus in the sole
C. is a bipennate muscle that arises from both bones of the leg
D. is the bulkiest and most powerful of the three deep muscles of the calf
E. is superficial to the neurovascular bundle

A

C
Last’s 9th Ed., p195-6.
Flex dig longus
Arises - posterior shaft of tibia below soleal line and by broad aponeurotic fibres from fibula
Inerts - Base of distal phalanges lateral four toes
Action - flexes distal phalanges of lateral four toes and flexes foot at ankle. Supports lateral longitudinal arch
N - tibial S23
Medial two tendons recieve slips from flex hal longu. all four recieve insertion of flexor accorius and each gives a lumbrical

59
Q

15340 – The gastrocnemius muscle
1: originates partly from the popliteal surface of the femur just above the medial condyle
2: is innervated by the tibial nerve
3: is attached through the tendo calcaneus to the middle third of the posterior surface of the calcaneus
4: has its dominant blood supply from the inferior genicular arteries

A

TTTF
ANATOMY Page 72 of 215
Refer to Last, 10th Ed, Ch 3, page 141-142.
Gastrocnemius
Arises :
LAT HEAD - posterior surface of lateral condyle of femur and highest of three facets on lateral condyle.
MED HEAD - posterior surface of femur above medial condyle
Inserts:
Tendocalcaneus to middle of three facets on posterior aspect of the calcaneus
Action - Plantar flexes foot. Flexes knee.
N Tibial n S12
Main propulsive force for jumping
Blood supply - lateral and medial sural arteries which are branches of the popliteal artery

60
Q

7712 – S: The strength of plantar flexion by gastrocnemius is increased by simultaneous extension of the knee because R: the foot acts as a lever during plantar flexion

A

S is true, R is true but not a valid explanation of S
Last 10th ed, Ch 3

61
Q

21378 – The soleus muscle
1: arises from the tibia and fibula
2: is active while walking downstairs
3: is a plantar flexor of the foot at the ankle joint
4: has a tendon which begins at a higher level than that of the gastrocnemius muscle

A

TTTF
Last PAGE: 173
SOLEUS
Arises - soleal line and middle third of posterior border of tibia, and upper quarter of posterior shaft of fibula including neck
INSERTS - tendocalcaneus to middle of three facets on posterior surface of calcaneus
ACTION - plantar flexes foot (aids venous return)
N tibial S12
Main propulsive force for walking and running

62
Q

21358 – The tibial nerve
1: is superficial to the popliteal vessels in the popliteal fossa
2: gives branches to the muscles which dorsiflex the foot
3: gives branches to the knee and ankle joints
4: gives off the sural nerve to the medial side of the leg and foot

A

TFTF
Last PAGE: 15
2- muscles that plantarflex the foot
4 - sural nerve to the LATERAL side of leg and foot

63
Q

14848 – The tibial nerve
A. is derived from the ventral rami of L4, L5, S1, S2 and S3
B. lies medial to the popliteal vessels in the upper part of the popliteal fossa
C. gives off the lateral sural nerve
D. supplies the short head of the biceps femoris
E. has none of the above properties

A

A
Refer to Last, 10th Ed, page 148, 149, 158, 320

B - Lies lateral
C - gives off sural nerve - LATERAL SURAL IS COMMON FIBULAR
D - tibial portion of sciatic supplies LONG head of biceps femoris. fibular supplies the short head

Enters the fossa lateral to artery but in the fossa but then artery crosses deep to it to become lateral and nerve medial
Crosses posterior tibial artery from medial to lateral half way down the calf

64
Q

12733 – The common peroneal nerve is distributed to
1: the skin between the third and fourth toes
2: the knee joint
3: the skin of the lateral side of the calf
4: all the muscles producing eversion of the foot

A

TTTT
The common peroneal nerve passes the knee joint and supplies it in accordance with Hilton’s law (B true). On the lateral head of gastrocnemius it gives off the lateral cutaneous nerve of the calf (C true), and then divides into superficial and deep peroneal nerves just below the neck of the fibula. The superficial peroneal nerve supplies the evertors of the foot (D true) and ends by dividing into medial and lateral cutaneous branches on the dorsum of the foot. A division of the lateral branch supplies the
cleft between third and fourth toes (A true).

65
Q

19911 – The deep peroneal nerve supplies
A. popliteus
B. plantaris
C. skin on the lateral side of the dorsum of the foot
D. peroneus longus
E. peroneus tertius

A

E
Last 8th ed. PAGE: 188
A - popliteus is tibial nerve
B - plantaris is tibial nerve
C- skin on lateral dorsum is superficial peroneal
D - peroneus/fibularis longus is superficial peroneal (L5S1)

66
Q

19186 – The motorneurones responsible for the knee-jerk are located mainly in spinal cord segments
A. L1, L2
B. L2, L3
C. L3, L4
D. L4, L5
E. L5, S1

A

Answer: C
Last PAGE: 28

67
Q

21051 – S. Division of the superficial peroneal nerve results in foot drop BECAUSE R. the superficial peroneal nerve supplies the tibialis
anterior muscle

A

both S and R and false
Last PAGE: 171
DEEP fibular nerve supplies the dorsiflexors tibialis ant etc.

68
Q

19042 – A patient has foot drop and anaesthesia over the dorsum of the foot except on the lateral side. The lesion is likely to involve the
A. tibial and peroneal nerves
B. common peroneal nerve
C. lumbosacral trunk
D. ventral rami of S1 and S2
E. tibial nerve

A

Answer: B
Last PAGE: 165

69
Q

23744 – Fibres of the fourth lumbar spinal nerve
1: supply skin between the first and second toes
2: are found in the femoral nerve
3: are found in the tibial nerve
4: are found in the common peroneal nerve

A

Answers: FTTT
Last PAGE: 27, 311, 358
Sciatic is L4 - S3
Femoral is L2-4

70
Q

21823 – The ventral primary ramus of L4 is distributed to
1: the skin of the medial side of the leg
2: muscles which dorsiflex the ankle joint
3: muscles which invert the foot
4: muscles which flex the knee joint

A

TTTF
Last 8th ed. PAGE: 186-187, 195
Myotomes leg:
Knee ext L3/4
Knee flex L5/S1
Dorsi flexion L4/5
Plantar flexion S1/2
Inversion L4/5, eversion L5/S1

71
Q

19048 – The cutaneous innervation over the medial malleolus at the ankle is derived from which of the following spine segments?
A. L3
B. L4
C. L5
D. S1
E. S2

A

B
Last 8th ed. PAGE: 25
Medial leg saphenous L4
big toe L4,
Lateral leg and bottom of sole in the middle L5, - superficial peroneal
little toe sural S1
deep peroneal between 1-2 toes - L4/5

72
Q

14962 – The great (long) saphenous vein
1: has more valves above the knee than below
2: is intimately related to the saphenous nerve in the leg
3: is connected to the deep veins by perforating vessels whose valves contain muscular sphincters derived form the tunica media
4: is anterior to the medial malleolus

A

FTFT
Refer to Last, 10th Ed, page 147, 185; Wheater, page 127
1 - more valves below the knee
2 - related to saphenous nerve
4 - anterior to medial malleolus

originates from where dorsal vein of big toe merges with dorsal venous arch of the foot.
passes anterior to medial malleolus -
runs up medial side of leg
at knee it runs over posterior border of medial epicondyle of femus.
3-4 cm inferolateral to the pubic tubercle it dives down deep through the cribriform fascia to join the femoral vein. - saphenous arch.
most tributaries join near junction with common femoral vein.
in the lower leg it anastomoses with the small saphenous , it communicates via perforator veins with anterior and posterior tibial veins.
communicates with pop vein by boyd perforator.

73
Q

22254 – In the region of the ankle joint
1: the posterior tibial artery can be palpated behind the medial malleolus
2: the anterior tibial artery can be palpated between the tendons of the extensor hallucis longus and extensor digitorum longus
3: the flexor retinaculum is attached to the medial malleolus above and the calcaneus below
4: the dorsalis pedis artery terminates at the distal end of the first intermetatarsal space

A

TTTF
Last 10th Ed, Ch 3 PAGE: 141-145.

74
Q

19947 – The talus articulates with all EXCEPT which of the following?
A. the tibia
B. the navicular
C. the posterior tibiofibular ligament
D. the inferior calcaneonavicular ligament
E. the long plantar ligament

A

E
Last PAGE: 181, 182, 184

75
Q

12723 – The sustentaculum tali
1: gives partial attachment to the spring ligament
2: is a projection from the calcaneus
3: supports the head of the talus
4: gives partial attachment to the deltoid ligament

A

TTT
The sustentaculum tali is a shelf projecting from the upper part of the medial surface of the calcaneus supporting the head of the talus (B and C true). The rounded medial border of the sustentaculum tali gives attachment over its whole thickness to the spring ligament in front and the superficial lamina of the deltoid ligament behind (A and D true)

76
Q

24224 – The deltoid ligament is attached to the
1: medial malleolus
2: sustentaculum tali in continuity with the inferior transverse ligament
3: inferior calcaneo-navicular (spring) ligament
4: tuberosity of the navicular

A

TFTT
Last 8th ed. PAGE: 203.
The deltoid (medial) ligament of the ankle is an extremely strong ligament arising from the lower border of the medial malleolus (A true) and having a long distal attachment extending from the body of the talus posteriorly, along the sustentaculum tali, talar neck and the medial edge of the spring ligament to the tuberosity of the navicular (C,D true).

77
Q

12738 – The deltoid ligament is attached to the
1: medial malleolus
2: sustentaculum tali
3: inferior calcaneo-navicular (spring) ligament
4: tuberosity of the navicular

A

TTTT
The deltoid (medial) ligament of the ankle is an extremely strong ligament arising from the lower border of the medial malleolus (A true) and having a long distal attachment extending from the body of the talus posteriorly, along the sustentaculum tali, talar neck and the medial edge of the spring ligament to the tuberosity of the navicular (B,C,D true).

78
Q

19905 – On the anterior aspect of the ankle joint the tendon of the extensor hallucis longus
A. is medial to the tibialis anterior
B. is lateral to the deep peroneal nerve
C. is lateral to the extensor digitorum longus
D. possesses no synovial sheath
E. is medial to the anterior tibial artery

A

E
Last PAGE: 169
Medial to lateral, EHL, dorsalis pedis artery and vein, deep branch of common fibular nerve.

79
Q

22869 – The lateral plantar artery
1: anastomoses with the medial plantar artery to complete the plantar arch
2: crosses the sole obliquely on the lateral side of the lateral plantar nerve
3: lies deep to the flexor accessorius muscle
4: anastomoses with dorsalis pedis and arcuate arteries

A

FTFT
Last 8th ed. PAGE: 202
arises from posterior tibial artery deep to abductor hallucis.
lateral plantar supplies plantar metatarsal, medial plantar superficial digital branches

80
Q

21538 – The muscles which are commonly supplied by the medial plantar nerve include
1: the adductor hallucis
2: the flexor hallucis brevis
3: the flexor accessorius (quadratus plantae)
4: the first lumbrical muscle

A

FTFT
Last 8th ed. PAGE: 196-200
Medial plantar nerve from tibial nerve
- Supplies: abducor hallucis, flexor dig brevis, flex hallucis longus, first lumbrical, skin of sole and 3 1/2 toes.
- arises beneath flexor retinaculum and runs with the medial plantar artery around the sustenaculum tali of the calcaneous deep to the abductior hallucis.
- it pierces the planta fascia in so doing and runs forward over the tendon of flexor digitorum longus to appear more superficially again between the abductor hallucis and the flexor digitorum brevis in the sole of hte foot

Lateral plantar nerve from tibial nerve
- arises beneath flexor retinaculum and runs forwards with lateral plantar artery around sustenaculum tali of calcaneous deep to ab hall. runs over flex dig accesorius beneath flex dig brevis,
- supplies skin of lateral sole, flex dig accesorius, abductor digiti minimi, adductor hallucis, plantar interossei and 1-3 dorsal interossei. skin on 1 + 1/2 toes, flex dig minimi brevis.

81
Q

19533 – Flexion of both hip and knee joints is produced by
A. rectus femoris
B. semitendinosus
C. biceps femoris
D. sartorius
E. tensor fasciae latae

A

D
Last PAGE: 136

82
Q

19438 – Which of the following lies in the second muscular layer of the
sole?
A. peroneus longus tendon
B. abductor digiti minimi
C. flexor accessorius
D. flexor digitorum brevis
E. flexor digiti minimi brevis

A

C
Last 8th ed. Page: 197-201
1st layer:
- ab hal, flex dig brev, ab dig mini,
second layer
- quadratus plantae/flexor accessorius, lumbricals
third layer
- flex hal brev, add hal, flex dig mini brevis,
fourth later:
- plantar and dorsal interossei

83
Q

21383 – The flexor hallucis longus
1: arises from the inferior two-thirds of the posterior surface of the shaft of the tibia
2: grooves the posterior surface of the medial malleolus
3: crosses superficial to the tendon of the flexor digitorum longus in the sole of the foot
4: grooves the posterior aspect of the talus

A

FFFT
Last 8th ed. PAGE: 195
Arises - lower two thirds of posterior fibular (between median crest and posterior border), lower intermuscular septum + interosseus membrane
Inserts - base of distal phalanx of big toe and slips to medial two tendons of FDL
Action - flexes distal phalanx of big toe. Flexes foot at ankle, supports medial longitudinal arch
nerve - Tibial Nerve.

Relations: passes through the tarsal tunnel. most lateral structure in the tarsal tunnel adjacent to tibial nerve.
it is crosssed by flexor digitorum longus on plantar aspect of foot. attaches distal to attachemnt of soleus muscles

84
Q

19276 – Extensor digitorum longus
A. crosses the ankle joint medial to tibialis anterior
B. crosses the ankle joint medial to extensor hallucis longus
C. crosses the ankle joint lateral to the deep peroneal nerve
D. supplies tendons to the medial four toes
E. does none of the above

A

Answer: C
Last PAGE: 170
Arises - upper two thirds of anterior shaft of fibula, interosseus membrane and superior tibiofibular joint.
inserts - extensor expansion of lateral four toes
Action - Extends toes and extends foot at ankle
Nerve - Deep fibular (peroneal)

passes under the superior and inferior extensor retinaculum of foot with fibularis tertius and divides into four slips

85
Q

20343 – S. Mobility of the first metatarso-phalangeal joint is important in normal walking BECAUSE R. flexor hallucis longus is a powerful contributor to the propulsive force of the foot

A

Answer: S is true, R is true and a valid explanation of S
Last PAGE: 188

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