Lower limb Flashcards

Question

With respect to the great saphenous vein, which of the following is true? A It is a continuation of the lateral marginal vein of the foot B It pierces the cribriform fascia covering the saphenous opening C It runs between the two heads of gastrocnemius D It does not communicate directly with the superficial vein varicosities

Answer 1

B Explanation The great saphenous vein is a continuation of the medial marginal vein of the foot. It does not run between the 2 heads of gastrocnemius, and does communicate directly with the superficial vein varicosities.

Answer 2

C Explanation Patella Ligament: From inferior border of patella to tibial tuberosity; is the continuation of quadriceps tendon. Tibial collateral ligament: Broad flat band attached on medial epicondyle of femur (below adductor tubercle) - runs downward and forward to the medial condyle of the tibia - is crossed by the tendons of sartorius, gracilis and semitendinosus - attaches to meniscus. Fibular collateral ligament: Round cord from lateral epicondyle of femur (above groove of popliteus), runs downward and backward to head of fibula - is primarily covered by the tendon of biceps femoris Obliques popliteal ligament: Extension of semimembranosus - attached above the lateral condyle of femur - forms the floor of popliteal fossa and is in contact with popliteal artery. Arcuate popliteal ligament: Y-shaped - from the posterior border of the intercondylar area of tibia and the lateral epicondyle of femur to the area below the head of fibula. Transverse ligament - is an intra-capsular ligament. Slender fibrous band that joins anterior edges of menisci, crossing the anterior intercondylar area and tethering the menisci to each other during knee movement.

Answer 3

D Explanation the common peroneal nerve gives off the following branches Sural communicating nerve Lateral cutaneous nerve of the calf Superior and inferior genicular nerves The recurrent genicular nerve The common peroneal nerve ends by dividing, in the substance of peroneus longus, into the deep and superficial peroneal nerves The medial sural cutaneous nerve is a branch of the tibial nerve which joins the sural communicating branch of the common fibular (peroneal nerve)

Answer 4

C Explanation Deep to the superior extensor retinaculum lie the tendons of tibialis anterior, extensor hallucis longus, extensor digitorium longus and peroneus tertius, in that order from medial to lateral, in front of the lower end of the tibia. The anterior tibial artery and deep peroneal nerves are also deep to the retinaculum, lying between extensor hallucis longus and extensor digitorium longus, with the vessels medial to the nerve. Extra: Mnemonic (medial to lateral) Timothy Has A Very Nasty Disease, Fungal Toe. (Tibialis anterior tendon, extensor hallucis longus, tibial anterior Artery, tibial anterior Vein, deep fibular Nerve, extensor digitorium longus and peroneus tertius)

Answer 5

D Explanation The muscles are supplied by the superficial peroneal nerve (L5, S1, S2). Peroneus longus arises from the head and superior two thirds of the lateral surface of the fibula-and attaches to the base of the first metatarsal and medial cuneiform and the intermuscular septum (note: Older textbook state that the peroneus (fibularis) longus also arises from the intermuscular septa. This point should be removed if the question is to be used as the answer must come from the most current TB only). I have left the question as is because it is an older question-likely written using the older textbooks. Peroneus brevis from the inferior two thirds of the lateral surface of the fibula. There is no official blood supply to the lateral compartment of the leg. The peroneal muscles evert the foot and weakly plantarflexes the ankle. The lateral compartment ends inferiorly at the superior fibular retinaculum. Here the tendons of the two muscles enter a common synovial sheath to accommodate their passage between the superior fibular retinaculum and the lateral malleolus. Peroneus tertius is a muscle of the anterior compartment. It aids in dorsiflexion of the ankle and eversion of the foot. The peroneal muscle tendons share the same tendon sheath from above the lateral malleolus to the peroneal trochlea. The peroneal trochlea is distal to the lateral malleolus Peroneus is the same as fibulairs

Answer 6

C Explanation Popliteus arises on the posterior surface of the tibia above the soleal line (below the tibia condyles). It slopes upwards and laterally and it acts to unlock the knee in full extension. It is innervated by the tibial nerve. Origin: Lateral surface of lateral condyle of femur and lateral meniscus Insertion: Posterior surface of tibia, superior to soleal line Nerve: Tibial nerve (L4, L5, S1) Action: Weakly flexes knee and unlocks it by rotating femur 5° on flexed tibia; medially rotates tibia of unplanted limb

Answer 7

A Explanation Current textbook Hilton’s law states that a nerve that innervates a joint also tends to innervate the muscles that move the joint and the skin covering the distal attachments of those muscles Articular rami arise from the intermuscular rami of the muscular branches or directly from named nerves. A knowledge of the nerve supply of the muscles and their relationships to the joints can allow one to deduce the nerve supply of many joints. Possible deductions regarding the hip joint and its muscular relationships include: Flexors innervated by the femoral nerve pass anterior to the hip joint; the anterior aspect of the hip joint is innervated by the femoral nerve. Lateral rotators pass inferior and posterior to the hi[ joint; the inferior aspect of the joint is innervated by the obturator nerve and the posterior aspect is innervated by branches from the nerve to the quadratus femoris. Abductors innervated by the superior gluteal nerve pass superior to the hip joint; the superior aspect of the joint is innervated by the superior gluteal nerve Other sources The nerves supplying the hip joint are the femoral nerve, obturator nerve, nerve to quadratus femoris and twigs of the sciatic nerve A difficult question, but important to be aware of!

Answer 8

C Explanation Tibialis posterior causes inversion Peroneus tertius causes eversion and dorsiflexion Peroneus longus gives rise to eversion.

Answer 9

B Explanation The femoral artery is separated from the hip joint by psoas major. It enters the femoral triangle deep to sartorius. The profunda branch is its major offshoot Extra: The femoral artery is a continuation of the external iliac artery distal to the inguinal ligament. It is the primary artery of the lower limb. It enters the femoral triangle deep to the inguinal ligament midway between the ASIS and the pubic symphysis, between the femoral nerve laterally and the femoral vein medially. Definitions: Mid-inguinal point – halfway between the pubic symphysis and the anterior superior iliac spine. The femoral pulse can be palpated here. Midpoint of the inguinal ligament – halfway between the pubic tubercle and the anterior superior iliac spine (the two attachments of the inguinal ligament) Source NIH

Answer 10

C Explanation It is the most superficial of the gluteal muscles. It laterally rotates and extends the hip. It does not form the crease of the gluteal fold. The fold of the buttock is the transverse skin crease for the hip joint and is not caused by the lower border of gluteus maximus, which crosses the line of the fold obliquely The current text book says: The gluteal fold (sulcus) coincides with the inferior border of the gluteus maximus and indicates the separation of the buttock from the thigh. Coincides-but does not say form. Web search: The gluteal sulcus (also known as the gluteal fold, fold of the buttock or horizontal gluteal crease) is an area of the body of humans described by a horizontal crease formed by the inferior aspect of the buttocks and the posterior upper thigh. The gluteal sulcus is formed by the posterior horizontal skin crease of the hip joint and overlying fat, and is not formed by the lower border of the gluteus maximus muscle, which crosses the fold obliquely

Answer 11

D Explanation The hip joint is limited in full extension by the iliofemoral ligament. . The ischiofemoral is the weakest ligament. Note (in some sources): the hip joint is innervated by the femoral nerve (flexors + anterior aspect of hip joint), obturator nerve (lateral rotators + inferior aspect of hip joint), the nerve to quadratus femoris (posterior aspect of hip joint) and superior gluteal (adductors + superior aspect of the hip joint). There is no mention of the sciatic nerve In other sources: The nerves supplying the hip joint are the femoral nerve, obturator nerve, nerve to quadratus femoris and twigs of the sciatic nerve A difficult question, but important to be aware of

Answer 12

C Explanation Infero-lateral/medial border: gastrocnemius Superolateral: biceps femoris Superolateral: semimembranosus, semitendinosus Roof: fascia lata Floor: popliteal surface of femur, post joint capsule, popliteal fascia over popliteus Contents: Termination of small saphenous vein Popliteal arteries and veins and branches/tributaries Tibial and common fibular nerves Posterior cutaneous nerve of thigh Popliteal lymph nodes and lymphatic vessels The sural nerve is a branch of the tibial nerve and the common peroneal nerve.

Answer 13

B Explanation Tibialis anterior dorsiflexes and inverts the foot. It arises from the upper 2/3 of the tibia. It does not share its site of origin with peroneus tertius (PT or fibularis tertius). PT inserts into the dorsum of base of the 5th metatarsal. PT shares a sheath with extensor digitorium longus (EDL) Note: An older question, in older textbook it is clear TA arises from the upper two thirds of the extensor surface of the tibia, from the interosseous membrane and from the deep fascia overlying it. PT arises from the lower third of the fibula. Current textbook: TA-proximal attachment- lateral condyle and superior half of the lateral surface of tibia and interosseous membrane. Distal attachment-Medial and inferior surfaces of medial cuneiform and base of first metatarsal. PT-proximal attachment-inferior third of anterior surface of the fibula and interosseous membrane. Distal attachment- dorsum of base of 5th metatarsal.

Answer 14

D Explanation Deep to the superior extensor retinaculum lie the tendons of tibialis anterior, extensor hallucis longus, extensor digitorium longus and peroneus tertius, in that order from medial to lateral, in front of the lower end of the tibia. The anterior tibial and deep peroneal nerve are also deep to the retinaculum, lying between extensor hallucis longus and extensor digitorium longus, with the vessels medial to the nerve A good mnemonic to remember the structures behind the superior extensor retinaculum (from medial to lateral) is: "Timothy Has A Very Nasty Disease, Paratyphoid." - T = Tibialis anterior H = extensor Hallucis longus A = Artery V = Vein N = Nerve D = extensor Digitorum longus PT = Peroneus tertius

Answer 15

A Explanation The medial plantar nerve supplies the skin of the medial side of the sole of foot and sides of the first three digits. The lateral plantar supplies skin on the sole lateral to a line splitting the 4th digit. The sural nerve supplies the extensors on the lateral side of the foot and little toe. The deep peroneal nerve supplies the first inter-digital cleft. The superficial peroneal nerve supplies the third inter-digital cleft

Answer 16

B Explanation L3= anterior and medial thigh and knee L4= medial leg, medial ankle and side of foot L5= lateral leg, dorsum of foot, medial sole, 1-3 toes S1= lateral ankle, lateral side of dorsum and sole of foot, 4-5 toes S2= Posterior leg, posterior thigh, buttocks and penis

Answer 17

B Explanation Hilton’s law; A nerve that innervates a joint also tends to innervate the muscles that move the joint and the skin that covers the distal attachments of those muscles Nerves supplying the hip joint are the femoral nerve, obturator nerve, nerve to quadratus femoris and the superior gluteal nerve. Note: some older texts report that there are articular twigs from the sciatic nerve which supply the hip joint Interestingly, in the current textbook, the movement of the hip joint encompasses: flexors, adductors, lateral rotators, extensors, abductors and medial rotators. Lateral rotators include gluteus maximus. This muscle is supplied by the inferior gluteal nerve. This nerve however, is not part of the nerves supplying the hip joint which seems in contrary to Hilton's law. I have asked a few anatomists and the general response is that the law holds true but with some exceptions. See the next quote and source- "one OFTEN finds that a nerve that innervates a joint also tends to innervate the muscles that move the joint and the skin that covers the distal attachments of those muscles". I-Hilton, J. (1863). However, Hilton's law is actually an axiom, not a law. In general, axioms are generally true and therefore not always law. In his 13 lectures he further expounds on this. It is an AXIOM, not a dictum. A dictum creates a LAW (truth). Another websource: https://www.physio-pedia.com/Hip_Anatomy The hip joint receives innervations from the femoral, obturator and superior gluteal nerves.

Answer 18

A Explanation The medial collateral ligament of the knee (also called the tibial collateral ligament), has its posterior apex of the triangular ligament blended with the capsule of the knee and attaches to the medial meniscus. Extracapsular ligaments of the knee joint Fibular (lateral) collateral ligament Tibial (medial) collateral ligament Oblique collateral ligament Arcuate popliteal ligament Intra-articular ligaments of the knee joint Cruciate ligaments- anterior and posterior The menisci-medial and lateral Transverse ligament of the knee

Answer 19

D Explanation Peroneus tertius and the deep peroneal nerve lies in the anterior compartment of the leg. Peroneus longus passes through the inferior compartment - inferior to the fibular trochlea on the calcaneus - and enters a groove on the anterior inferior aspect of the cuboid bone Extra: The muscles are supplied by the superficial peroneal nerve (L5, S1, S2). Peroneus longus arises from the fibula and the intermuscular septum and peroneus brevis from the inferior two thirds of the lateral surface of the fibula. There is no official blood supply to the lateral compartment of the leg. The peroneal muscles evert the foot and weakly plantarflexes the ankle. The lateral compartment ends inferiorly at the superior fibular retinaculum. Here the tendons of the two muscles enter a common synovial sheath to accommodate their passage between the superior fibular retinaculum and the lateral malleolus. Peroneus tertius is a muscle of the anterior compartment. It aids in dorsiflexion of the ankle and eversion of the foot. Peroneus is the same as fibulairs Note: Peroneus=Fibularis

Answer 20

D Explanation The deep peroneal nerve reaches the anterior tibial artery from the lateral side, runs in front of it in the crowded space of the middle of the leg and returns to its lateral side below. The anterior tibial artery is accompanied by 2 anterior tibial veins running on either side.

Answer 21

C Explanation The common fibular nerve in the nerve most often injured in the lower limb due to its superficial position. It winds around the fibular neck making it very vulnerable to trauma. The nerve may be injured during fracture of the fibular neck or severely stretched when the knee joint is dislocated or fractured. Injury results in flaccid paralysis of all the muscles in the anterior and lateral compartment of the lower limb (dorsiflexion and evertors of the foot). The loss of dorsiflexion causes foot drop. This is further exacerbated by the unopposed inversion of the foot, causing a high stepping gait to avoid the toes hitting the ground during the swing phase of walking. Sensory loss extends over the lower lateral part of the leg and the dorsum of the foot. Extra: If the common fibular nerve is damaged, the patient may lose the ability to dorsiflex, evert the foot, and extend the digits. Source: physio -pedia

Answer 22

A Explanation L5- dermatome involves the lateral part of the leg, dorsum of the foot and the medial sole. L5 is involved in hip extension, knee flexion, foot eversion (and inversion according to CM) and big toe dorsiflexion. The lateral rotators of the hip consists of the externus and internus obturator muscles, piriformis, superior and inferior gemelli and quadratus femoris. Obturator externus: obturator nerve (L3, L4) Obturator internus: nerve to obturator internus (L5 S1) Piriformis: Branch of anterior rami (S1, S2) Superior gemelli: nerve to obturator internus (L5 S1) Inferior gemelli: nerve to quadratus femoris (L5, S1) Quadratus femoris: nerve to quadratus femoris (L5, S1) Note: Bold denotes the main segmental innervation. (Therefore lateral rotation will not be lost completely). I feel that "Inability to dorsiflex the big toe" is the most correct answer. Also, the old textbook displays L5 as foot eversion only and L4 foot inversion. The current textbook reads that L5 does both inversion and eversion of the foot.

Answer 23

A Explanation The sacroiliac joints are strong weight baring compound joints, consisting of a anterior synovial joint (between the articular surfaces of the sacrum and ilium, covered by articular cartilage) and a posterior syndesmosis (between the tuberosities of the same bones). The articular surfaces have irregular but congruent elevations and depressions that interlock. The SI joint differs form other synovial joint as it limited mobility is allowed, a consequence of their role in transmitting the weight of most of the body to the hip bones. The sacroiliac joints like all spinal joints (except the atlanto-axial) are bicondylar joints, meaning that movement of one side corresponds to a correlative movement of the other side.

Answer 24

B Explanation The plantar aponeurosis (PA) is composed of dense collagen fibres. It forms the central compartment of the sole. It arises from the medial process of calcaneous and fans out over the sole. The PA becomes broader and thinner in front, and divides near the heads of the metatarsal bones into five processes, one for each toe. At the anterior end of the sole, inferior to the heads of the metatarsals, the aponeurosis is reinforced by transverse fibres forming the superficial transverse metatarsal ligament. In the mid and forefoot, vertical intermuscular septa extend deeply from the margins of the plantar aponeurosis toward the first and fifth metatarsals forming three compartments of the sole- the medial, lateral and central. Fibrous septa anchor the skin to the underlying aponeurosis and limit the mobility of the skin. The medial and lateral plantar nerves supply the muscles and skin of the sole of the foot. These two nerves are the terminal branches of the tibial nerve. The four muscle layers of the foot begin with the superficial or first layer beneath the PA. The abductors of the big and little toes are covered by a deep fascia that is much thinner than the central aponeurosis.

Answer 25

A Explanation The anterior cruciate ligament (ACL) is the weaker of the two ligaments. It arises from the anterior intercondylar area of the tibia, posterior to the attachment of the medial meniscus. It extends superiorly, posteriorly and laterally to attach to the posterior part of the medial side of the lateral condyle of the femur. It limits posterior rolling of the femoral condyles on the tibial plateau during flexion and it prevents hyperextension of the knee joint and posterior displacement of the femur on the tibia. It has a relatively poor blood supply. The posterior cruciate ligament (PCL)- stronger of the two ligaments, arises form the posterior intercondylar area of the tibia and extends superiorly and anteriorly on the medial side of the ACL to attach to the anterior part of the lateral surface of the medial condyle of the femur. The PCL limits anterior rolling of the femur on the tibial plateau during extension. It helps prevent hyperflexion of the knee joint and prevents anterior displacement of the femur on the tibia or posterior displacment of the tibia on the femur. The PCL is the main stabilizing factor for the femur when in the weight bearing flexed knee

Answer 26

C Explanation The extracapsular ligaments of the knee comprise the 1-patellar ligament, 2-fibular collateral ligament, 3-tibial collateral ligament, 4-oblique popliteal ligament and the 5-arcuate popliteal ligament. PL: it is the anterior ligament of the knee. It is the distal part of the quadriceps tendon. Laterally it receives the medial and lateral retinacula. The PL inserts into the tibial tuberosity FCL: a cord like ligament extending inferiorly form the lateral epicondyle of the femur to the lateral surface of the fibular head. The tendon of biceps femoris is split in two by this ligament TCL: flat, intrinsic band that extends from the medial epicondyle of the femur to the medial condyle and superior part of the medial surface of the tibia. TCL is weaker than the FCL and is more damaged OPL: arises posterior to the medial tibial condyle and passes superolaterally toward the lateral femoral condyle, blending with the central part of the posterior aspect of the joint capsule. APL: arises from the posterior aspect of the fibular head, passes superomedially over the tendon of popliteus and spreads of the posterior surface of the knee joint

Answer 27

D Explanation Clinical features found following a fibular neck fracture/injury include the following: Inability to dorsiflex ankle- foot drop, Inability to evert foot- you get unopposed inversion, weakness of the muscles of the anterior and lateral compartment-flaccid paralysis. Loss of sensation over the dorsum of the foot and the anterolateral aspect of the leg-the common fibular nerve-superficial branch innervates the web spaces 2, 3, 4 and the deep branch innervates the 1 web space Three compensatory actions occur: a waddling gait (lean to the opposite side-hiking the hip up), a swing out gait and a high stepping (steppage) gait (to ensure that the toes clear the ground) Extra: The common fibular (peroneal) nerve forms as the sciatic bifurcates at the apex of the popliteal fossa; descends through the popliteal fossa and follows the medial border of biceps femoris and its tendon; passes over posterior aspect of the head of fibula and then winds around neck of fibula deep to fibularis longus, where it divides into deep and superficial fibular (peroneal) nerves.

Answer 28

A Explanation The sciatic nerve is the largest nerve in the body. It is a continuation of the sacral plexus. The sciatic nerve is the most lateral nerve entering the greater sciatic foramen inferior to the piriformis. Medial to it are the inferior gluteal nerve and vessels, the internal pudendal vessels and the pudendal nerve. The sciatic nerve runs inferolaterally under the gluteus maximus muscle, midway between the greater trochanter and the ischial tuberosity. The nerve rests on the ischium and then passes posterior to the obturator internus, quadratus femoris and the adductor muscles. Due to its size, the sciatic nerve receives the sciatic artery, a branch of the inferior gluteal artery. It supplies no structures in the gluteal region. It supplies the posterior thigh muscles, all leg and foot muscles, and the skin of most of the leg and foot. All the articular branches to the joints are supplied by the sciatic nerve. Not a great question. Remember, some of the questions are old and are unlikely to be repeated. However, it is important to keep all questions in the bank and use them as learning tools.

Answer 29

B Explanation The biceps femoral (BF) muscle consists of two heads- a long and short head. The long head together with the semitendinosus and semimembranosus muscle form the hamstring muscles. The hamstring muscles have a common nerve supply- the tibial division of the sciatic nerve, The short head of biceps is innervated by the fibular division of the sciatic nerve. The main blood supply is form the perforating branches of the profunda femoris artery. The upper part of the hamstrings are supplied by the inferior gluteal artery and the popliteal artery. The main action of the BF is flexion of the leg, lateral rotation of leg when the knee is flexed and extension of the thigh (e.g. when starting to walk). The hamstring muscle's proximal attachment arises form the ischial tuberosity. Extra: For Clarity: Definition of Hamstring Muscle includes: (1) must cross the knee and insert below to either tibia or fibula (2) must attach to ischial tuberosity (short head does not fulfil this) (3) must flex the knee AND extend the hip (short head does not extend the hip) (4) must be innervated by the tibial nerve (which short head does not fulfil)

Answer 30

B Explanation NOTE: I am not sure of the answer. But it seems the closest abductor hallucis is innervated by S2 S3 (medial plantar nerve) this muscle abducts and flexes great toe. So, I think the more appropriate answer should be S2. Other thoughts: MTP and phalangeal dorsiflexion and plantarflexion Great toe used as example in diagram. L5S1 dorsiflexion; S1S2 plantarflexion The terms abduction and adduction of the toes are used with reference to an axis through the second toe. Thus, abduction of the big toe is a medial movement, away from the second toe as which occurs in dorsiflexion. Therefore L5,S1. Extra from a user: agree with the initial explanation, don't think the movement away from the second toe in dorsiflexion is in the right plane to count as abduction

Answer 31

D Explanation The sciatic nerve is the largest nerve in the body. It is a continuation of the sacral plexus. The sciatic nerve is the most lateral nerve entering the greater sciatic foramen inferior to the piriformis. Medial to it are the inferior gluteal nerve and vessels, the internal pudendal vessels and the pudendal nerve. The sciatic nerve runs inferolaterally under the gluteus maximus muscle, midway between the greater trochanter and the ischial tuberosity. The nerve rests on the ischium and then passes posterior to the obturator internus, quadratus femoris and the adductor muscles. It descends in the posterior thigh deep to biceps femoris, bifurcates into tibial and common fibular nerves at the apex of popliteal fossa. Due to its size, the sciatic nerve receives the sciatic artery, a branch of the inferior gluteal artery. It supplies no structures in the gluteal region. It supplies the posterior thigh muscles, all leg and foot muscles, and the skin of most of the leg and foot. All the articular branches to the joints are supplied by the sciatic nerve.

Answer 32

B Explanation The biceps femoris muscle has two heads of origin. Long head-arises from the ischial tuberosity in common with semitendinosus. Short head-has a long origin, from the whole length of the linea aspera and the upper part of the lateral supracondylar line of the femur. Note: the short head origin in the old prescribed TB says the whole length of the linea aspera and the upper part of the lateral supracondylar line of the femur. In the current TB it arises from the lateral lip of the inferior third of the linea aspera and supracondylar ridge of the femur. Distally the single tendon of biceps femoris muscle inserts into the head of the fibula Biceps femoris receives dual supply from tibia (long head) and common fibular (short head) part of sciatic nerve. The blood supply comes from the profunda femoris and its perforating branches Actions: The hamstrings (thus including semimembranosus and semitendinosus) flex the knee joint and extend the hip joint. In the semiflexed knee the biceps femoris laterally rotates the knee and the semimembranosus and semitendinosus medially rotate it Extra: The biceps femoris is innervation by which two nerves? (similar way to ask this question)

Answer 33

D Explanation The distal ends of the tibia and fibular form a malleolar mortise into which the pulley shaped trochlea of the talus fits. The joint formed is a hinge type synovial joint. The medial surface of the lateral malleolus articulates with the lateral surface of the talus. The tibia articulates with the talus in two places. The tibia's inferior surface forms the roof of the malleolar mortise and the tibia's medial malleolus articulates with the medial surface of the talus. The tibia flares outwards at both ends to provide an increased area for articulation and weight transfer. The ankle joint is quite unstable during plantarflexion because the trochlear is narrower posteriorly and, therefore lies loosely within the mortise. It is during plantar flexion that most ankle injures occur. The ankle is reinforced by the lateral ligament of the ankle-made of three separate ligament (anterior talofibular ligament, posterior talofibular ligament and calcaneofibular ligament) and medially by the medial ligament of the ankle (deltoid ligament)-made of four parts (tibionavicular part, tibiocalcaneal part, anterior and posterior tibiotalar parts)

Answer 34

D Explanation The perforating veins penetrate the deep fascia and contain valves that allow blood to flow only from the superficial veins to the deep veins. They pass through the deep fascia at an oblique angle so that when muscles contract and the pressure increases inside the deep fascia, the perforating veins are compressed. Compression of the perforating veins also prevents blood from flowing from the deep to the superficial veins. This pattern of blood flow, from superficial to deep, is important for complete and proper venous retrun from the lower limb because it enables muscular contractions to propel blood towards the heart against the pull of gravity

Answer 35

C Explanation Iliopsoas is the chief flexor of the thigh. It is the most powerful of the hip flexors with the longest range. Of the thigh flexors, it is the only muscle attached to the vertebral column, pelvis and femur. It is able to produce stability as well as movement. The flexors of the hip joint: pectineus, iliopsoas, psoas minor, iliacus and sartorius Note: The iliopsoas refers to the joined psoas and the iliacus muscles. The two muscles are separate in the abdomen, but usually merge in the thigh. As such, they are usually given the common name iliopsoas. The iliopsoas muscle joins to the femur at the lesser trochanter, and acts as the strongest flexor of the hip. Clinical orientated anatomy refers to the muscle as one: iliopsoas- its broad lateral part (iliacus), and its long medial part (psoas major) arise from the iliac fossa and lumbar vertebrae respectively. Thus it is the only muscle attached to the vertebral column, pelvis and femur

Answer 36

B Explanation Superficial fibular nerve. It is a terminal branch of the common fibular nerve. Deep fibular nerve - supplies anterior compartment of the leg

Answer 37

D Explanation They are found in the second layer of the foot. They perform the following functions: flex proximal phalanges, extend middle and distal phalanges of the lateral four digits (toes) Flexion of the lateral four toes=flexor digitorium brevis Abduct digits (2-4) and flex metatarsophalangeal joints (MTPJs)=dorsal interossei Adduct digits (3-5) and flex MTPJs= plantar interossei In review of this question, I don’t think it is a great one. The answers semms to come form the table in CM textbook. However if you do a web search on the function of the foot lumbricals, you get the following answer: By pulling the medial base of the proximal phalanx, the lumbrical muscles flex and adduct the toes at the metatarsophalangeal (MTP) joints. Conversely, by pulling the extensor expansions of the phalanges, the lumbricals extend the toes at the interphalangeal (IP) joints. These actions of the lumbrical muscles provide a balancing function to the foot. Flexion and adduction at the MTP joints oppose the extension of the long and short extensor of the toes and prevent hyperextension of the toes during the propulsive phase of gait. The extension at IP joints prevents clawing during gait as it opposes to the flexion produced by the long and short flexors of the toes. Source: kenhub.com I would keep to the textbook's answer, but I can see why it may be confusing everyone

Answer 38

A Explanation The tibial division of the sciatic nerve does not supply the short head of bicep femoris, but rather the long head. The common fibular division of the sciatic nerve supplies the short head of biceps femoris Adductor magnus is the largest, most powerful, and most posterior muscle in the adductor group. It has an adductor part and a hamstring part. The adductor part is supplied by the obturator nerve and the hamstring part by the tibial component of the sciatic nerve

Answer 39

B Explanation Looking at the dermatomal distribution of the lower limb in the prescribed textbook. Dermatome L5 would be responsible.

Answer 40

A Explanation The femoral ring is a weak area in the anterior abdominal wall and is the usual site of the origin of a femoral hernia-a protrusion of abdominal viscera (often a loop of small intestine) through the femoral ring into the femoral canal. A femoral hernia appears as a mass, often tender, in the femoral triangle, inferolateral to the pubic tubercle. The hernia is bounded by the femoral vein laterally and the lacunar ligament medially. The hernia sac (although initially small and contained within the wall of the canal) can enlarge by passing inferiorly through the saphenous opening into the subcutaneous tissues of the thigh. Femoral hernias are more common in females because of their wider pelvises.

Answer 41

D Explanation The superficial veins are located in the subcutaneous tissue and the deep veins are located beneath (deep) to the deep fascia and accompany all major arteries. Superficial and deep veins have valves, which are more numerous in the deep veins. The two major superficial veins in the lower limb are the great and small saphenous veins. Perforating veins penetrate the deep fascia close to their origin from the superficial veins and contain valves that allow blood to flow only form the superficial veins to the deep ones. The deep veins are contained within a vascular sheath with the artery, whose pulsations also help compress and move blood in the veins. The anterior tibial vein (anterior leg) and the posterior tibial and fibular veins (formed by the medial and lateral plantar veins of the foot) are all deep veins. The three deep veins drain into the popliteal vein which becomes the femoral vein in the thigh. The femoral vein passes deep to the inguinal ligament to become the external iliac vein

Answer 42

C Explanation Femoral neck fractures (NOF) are common in people >60yrs old, and more common in women (because they have weaker and more brittle bones at this age due to osteoporosis). Fractures of the femoral neck are often intracapsular. NOF fractures result in lateral rotation of the lower limb. Most of the blood supply to the head and neck of the femur is via the medial circumflex femoral artery and is disrupted by a NOF fracture. Following a NOF fracture, the artery to the ligament of the femoral head may be the only remaining artery which is often inadequate resulting in aseptic avascular necrosis of the femoral head

Answer 43

D Explanation The dorsalis pedis (DP) artery is a major source of blood supply to the forefoot. The DP is a direct continuation of the anterior tibial artery. The DP begins midway between the malleoli and runs anteromedially, deep to the inferior extensor retinaculum between the extensor halluces longus and the extensor digitorum longus tendons on the dorsum of the foot. The DP passes to the first interosseous space, where it divides into the first metatarsal artery and a deep planter artery. The deep plantar artery joins the lateral plantar artery to form the DEEP PLANTAR ARCH.

Answer 44

C Explanation The patella is a sesamoid bone in the quadriceps tendon. The patellar ligament is vertical, but the pull of the of the quadriceps is oblique, in the line of the shaft of the femur, and when the muscle contracts it tends to draw the patella laterally. Factors preventing lateral dislocation include: the forward prominence of the lateral femoral condyle, the ligamentous tension of the medial patella retinaculum and the lowest fibres of the vastus medialis. These fibres hold the patella medially when the quadriceps contracts and are indispensable to the stability of the patella

Answer 45

C Explanation The saphenous nerve accompanies the great saphenous vein anterior to the medial malleolus. It can be damaged during a venous cut down or by a ligature following closing of a surgical wound

Answer 46

D Explanation There are about 12 bursa around the knee joint Four bursae communicate with the synovial cavity of the knee joint. Suprapatellar, popliteus, anserine and gastrocnemius bursa. The large suprapatellar bursa is the most likely to lead to a septic joint infection. Although it develops separately for the knee joint, the bursa becomes continuous with it.

Answer 47

B Explanation The deep fibular nerve supplies sensation to the dorsal webspace between the 1st and 2nd toes. The superficial fibular nerve supplies sensation to the remainder of the dorsum of the foot. Branches of the tibial nerve, including the medial and lateral plantar nerves distally, and the medial calcaneal branches proximally, supply sensation to the plantar aspect of the foot. The saphenous nerve supplies sensation to the medial aspect of the foot and lower leg.

Answer 48

D Explanation Mytomes of ankle: Dorsiflexion: L4-5 Plantarflexion: S1-2 Inversion L4-5 Eversion L5-S1

Answer 49

C Explanation Trendelenburg gait is an abnormal gait resulting from defective hip abductor mechanism. Weakness of the gluteus medius and minimus muscles causes drooping of the pelvis of the contralateral side whilst walking. It can occur as a result of damage to the superior gluteal nerve.

Answer 50

D Explanation Structures attaching to the AIIS include the rectus femoris and the iliofemoral ligament.

Answer 51

C Explanation Femoral hernias are masses located in the femoral triangle, inferolateral to the pubic tubercle, They are bounded by the femoral vein laterally, and lacunar ligament medially. More common in females because of wider pelvis. Initially small, but can enlarge by passing inferiorly through the saphenous opening into subcut tissue of the thigh.

Answer 52

B Explanation Femoral hernias are masses located in the femoral triangle, inferolateral to the pubic tubercle, They are bounded by the femoral vein laterally, and lacunar ligament medially. More common in females because of wider pelvis. Initially small, but can enlarge by passing inferiorly through the saphenous opening into subcut tissue of the thigh.

Answer 53

A Explanation The blood supply to the neck and head of the femur is primarily via retinacular branches of the medical Cx artery, which is a branch of the profunda femoris artery. The obturator artery also gives some supply via the artery to the head of the femur.

Answer 54

C Explanation Inversion and eversion occur at the subtalar (talocalcaneal) and transverse tarsal (calcaneocuboid and talonavicular joints)

Answer 55

A Explanation Structures running posterior to the medial malleolus include the tibialis posterior, FDL, posterior tibial artery and vein, tibial nerve, FHL tendon. The small saphenous vein ascends on the lateral side of the foot. Contents (“Tom, Dick and A Very Nervous Harry”) Tibialis posterior tendon Flexor Digitorium longus tendon Posterior tibial Artery Posterior tibial Vein Tibial Nerve Flexor Hallucis longus tendon

Answer 56

C Explanation The location of structures in the femoral triangle, from lateral to medial, is femoral nerve, artery, vein, empty space, and lymph nodes. Extra:: acronym NAVEL helps: Nerve, Artery, Vein, empty space, and Lymph nodes

Answer 57

C Explanation Functions of the PCL include: Limits anterior rolling of femur on tibial plateau during extension Prevents posterior displacement of tibia on femur Prevents hyperflexion of knee joint Main stabilising factor for femur in weight bearing knee

Answer 58

A Explanation The medial superficial lymphatic vessels, larger and more numerous than the lateral ones, drain the medial side of the dorsum and sole of the foot. These vessels converge on the great saphenous vein and accompany it to the vertical group of superficial inguinal lymph nodes, and then to the deep inguinal lymph nodes.

Answer 59

A Explanation Iliolumbar artery (posterior division of internal iliac artery) supplies psoas major, iliacus, quadratus lumborum, cauda equina in vertebral canal. Internal iliac artery [Anterior divisions] Umbilical Obturator - (ant branch) supplies obturator externus, pectineus, thigh adductors, and gracilis; (post branch) supplies muscles attached to ischial tuberosity Inferior vesical Artery to ductus deferens Prostatic branches Uterine Vaginal Internal pudendal - supplies external genitalia & perineal m. Middle rectal Inferior gluteal - supplies glut maximus, obturator internus, quat femoris and superior parts of hamstrings [Posterior divisions] Iliolumbar - supplies psoas and quad lumborum Lateral sacral (superior and inferior) Superior gluteal - (superficial) glut maximus, (deep) glut medius/ minimus and TFL

Answer 60

C Explanation Because of its superficial position, the common fibular nerve is the nerve most often injured in the lower limb, mainly because it winds subcutaneously around the fibular neck, leaving it vulnerable to direct trauma. Severance of the common fibular nerve results in flaccid paralysis of all muscles in the anterior and lateral compartments of the leg (dorsiflexors of ankle and evertors of foot). The loss of dorsiflexion of the ankle causes footdrop, which is further exacerbated by unopposed inversion of the foot. Therefore, patient has high-stepping gait secondary to foot drop indicating common fibular nerve injury – the fibular neck (proximal fibula) is most likely affected

Answer 61

C Explanation The superficial fibular nerve supplies the fibularis longus and brevis which both evert the foot and weakly plantar flex the ankle (fibularis tertius dorsiflex and ankles and aids in eversion of the foot). Tibial nerve supplies posterior muscles of leg and knee joint. Sural nerve supplies skin on posterior and lateral aspects of leg and lateral foot. Saphenous nerve supplies skin on medial side of ankle and foot.

Answer 62

A Explanation The long head of the biceps femoris is innervated by the tibial division of the sciatic nerve (L5, S1, S2). The short head of the biceps femoris is innervated by the common fibular division of the sciatic nerve (L5, S1, S2). The adductor magnus also has two innervations – the adductor part supplied by obturator nerve, and hamstring part supplied by tibial part of sciatic nerve. Note: the sciatic nerve comprises both the tibial and fibular divisions. Therefore "2" nerves.

Answer 63

A Explanation Shin splints—oedema and pain in the area of the distal two thirds of the tibia— result from repetitive microtrauma of the tibialis anterior, which causes small tears in the periosteum covering the shaft of the tibia and/or of fleshy attachments to the overlying deep fascia of the leg. Shin splints are a mild form of the anterior compartment syndrome. Shin splints commonly occur during traumatic injury or athletic overexertion of muscles in the anterior compartment, especially TA, by untrained persons. Often, persons who lead sedentary lives develop shin splints when they participate in long-distance walks.

Answer 64

C Explanation L1 – inguinal region. L2 – lateral thigh. L3 – medial thigh/knee. L4 – medial leg. L5 – lateral leg/medial dorsum of foot. S1 = lateral foot. S2 = posterior thigh

Lower limb Flashcards

(88 cards)