Lower limb viva prep

Question 0

What are the parts of the hip bone?

Answer 0

The ilium
The ischium
The pubis

Question 1

What are the three articulations of the hip bone?

Answer 1

Sacroiliac joint - articulation with the sacrum
Pubic symphysis - articulation with corresponding hip bone
Hip joint - articulation with head of femur

Question 2

What joins the three parts of the hip bone prior to puberty?

At what age do they begin and complete to fuse?

Answer 2

The triradiate cartilage
Begin to fuse at age 15-17
Completed at age 20-25

Question 3

What are the bony landmarks of the ilium?

Answer 3

Anteriorly: iliac fossa on the wing of ilium (concave)
Iliac crest
ASIS (anterior superior iliac spine)
Anterior inferior iliac spine
Acetabulum
Posteriorly: gluteal surface of the wing of ilium (convex)
Posterior superior iliac spine

Question 4

Which muscles attach to the ilium?

Answer 4

Gluteal muscles - attach to external surface of the ilium at the anterior, posterior and inferior gluteal lines

Iliacus muscle - attaches medically at iliac fossa

Question 5

What is the clinical relevance of the ASIS?

Answer 5

Measure the true leg length from ASIS to medial malleolus

Discrepancy seen in hip disorders

Question 6

How do you measure the true leg length?

Answer 6

From ASIS to medial malleolus

Discrepancy seen in various hip disorders

Question 7

How do you measure the apparent leg length?

Answer 7

From the umbilicus to the medial malleolus

Question 8

Where does the inguinal ligament attach?

Answer 8

From ASIS to pubic tubercle

Question 9

What are the parts of the pubis?

Answer 9

Body (articulates at pubic symphysis) 
Superior rami (part of acetabulum)
Inferior rami (part of ischiopubic ramus)

Two rami form part of the border of obturator foramen

Question 10

What are the borders of the obturator foramen?

Answer 10

Inferior- ischiopubic rami (inferior ischial and pubic rami), part of body of ischium
Superior - superior ramus of pubis
Laterally - part of body of ischium, superior ischial ramus
Medial - body of pubis

Question 11

What are the contents of the obturator foramen?

Answer 11

Obturator nerve
Obturator artery
Obturator vein

Question 12

What are the parts of the ischium?

Answer 12

Body of the ischium
Superior and inferior ischial rami
Ischial spine
Posteriorly: Greater sciatic notch
Ischial tuberosity

Question 13

What ligaments attach to the ischium?

Answer 13

Sacrospinous ligament: ischial spine to sacrum
Form greater sciatic notch - neurovasculature of lower limb incl sciatic nerve & piriformis muscle

Sacrotuberous ligament: ischial tuberosity -> sacrum forming lesser sciatic notch

Question 14

How do fractures occur in the pelvic bone?

Answer 14

Direct trauma (vehicular accident)
Forces transmitted form the lower limb (heavy fall on the feet)

Question 15

Where do fractures occur on the pelvic bone?

Answer 15

Pubic rami
Acetabulum
Sacroiliac joint

Question 16

Borders of the femoral triangle

Answer 16

Superior border - inguinal ligament
Lateral border - medial border of sartorial
Medial border - medial border of adductor longus
(Pelvic floor - rest of adductor longus)
Roof - fascia lata
Base - pectineous, iliopsas, adductor longus muscles

Question 17

What is the function of the inguinal ligament at the femoral triangle?

Answer 17

Acts as a flexor retinaculum supporting the femoral triangle during Flexion At the hip

Question 18

Contents of the femoral triangle

Answer 18

Femoral nerve
Femoral artery
Femoral vein
Femoral canal- lymph nodes and vessels

Question 19

What is contained by the femoral sheath?

Answer 19

Femoral artery,vein and canal in a facial compartment aka the femoral sheath

Question 20

Why is there empty space in the femoral triangle?

Answer 20

To allow veins and lymph vessels to distend when coping with different levels of flow

Question 21

Where can you palmate the femoral pulse?

Answer 21

Inferior to where femoral artery crosses inguinal ligament

Midway between pubic symphysis and ASIS

Presence of femoral pulse = blood reaching lower extremity

Question 22

Describe the procedure of a coronary angiography

Answer 22

Superficial femoral artery in femoral triangle is catheterised with long thin tube
Navigated up external iliac artery, common iliac artery, aorta and into coronary vessels
Radioactive dye ejected into coronary vessels
Wall thickening or blockage can be visualised via xray

Question 23

How do you check arterial blood gasses ?

Answer 23

Catherine the femoral artery

Question 24

Define a hernia

Answer 24

Condition in which internal part of an organ is displaced and protrudes through a weakness in the muscle or the wall of the cavity containing it

Question 25

Describe a femoral hernia

Answer 25

``` Part of bowel pushes into femoral canal Protrudes through femoral ring Underneath inguinal ligament Manifests as clinical lump/bulge in area of femoral triangle Lump interolaterally to pubic tubercle ``` Requires surgical intervention to treat More common in woman due to wider bony pelvis Tough walls of femoral canal can result in a strangulated hernia

Question 26

Where is the femoral canal located?

Answer 26

It is an anatomical compartment In anterior thigh Smallest most medial part of femoral sheath Approx 1.3 cm long

Question 28

Contents of femoral canal

Answer 28

Lymphatic vessels - draining deep inguinal lymph nodes Deep lymph node - the lacunar node Empty space - allows distension of adjacent femoral vein Loos connective tissue

Question 29

What is a strangulated hernia?

Answer 29

Hernia with compromised blood supply

Question 30

Shape, location and function of popliteal fossa

Answer 30

Diamond shaped Posterior side of knee Path for structures to move from thigh to leg

Question 31

Borders of popliteal fossa

Answer 31

Superiomedial border - semimembranosus Superiolateral border - biceps femoris Inferiomedial border - medial head of gastrocnemius Inferiolateral border - lateral head of gastrocnemius and plantaris Floor - posterior surface of knee joint capsule, post surface of femur Roof - 2 layers: popliteal fascia (continuous with fascia lata of leg) and skin

Question 32

Contents of popliteal fossa

Answer 32

Popliteal artery Popliteal vein Tibial nerve Common fibular nerve

Question 33

What does the sciatic nerve split into, in the popliteal fossa?

Answer 33

Tibial nerve | Common fibular nerve

Question 34

What tendon does the fibular nerve follow?

Answer 34

Biceps femoris tendon

Question 35

What pierces the fascia of the popliteal fossa?

Answer 35

Small saphaneous vein | To empty into popliteal vein

Question 36

Describe a baker's cyst

Answer 36

Inflammation and swelling of the semimembranosus bursa (fluid filled sac in the knee joint) Arises with arthritis of knee (rheumatoid or osteo) Usually selfresolves - the cyst can rupture and produce symptoms similar to DVT

Question 37

What is the deepest structure in the popliteal fossa?

Answer 37

Popliteal artery

Question 38

What is the most superficial contents of the popliteal fossa?

Answer 38

Tibial and common fibular nerves

Question 39

What is an aneurysm?

Answer 39

Dilation of an artery greater than 50% of normal diameter

Question 40

Consequences of an aneurysm in the popliteal artery?

Answer 40

Popliteal fascial roof is tough and non extensible Compression of tibial nerve - leg anaesthesia/ loss of leg motor function Aneurysm can be palpated by obvious pulsation in fossa with abnormal arterial sounds

Question 47

What are the borders of the femoral canal?

Answer 47

Medial border - lacunar ligament Lateral border - femoral vein Anterior border - inguinal ligament Posterior border - pectineal ligament and superior rami of pubis Superior border - femoral ring, closed by CT layer (femoral septum) pierced by lymphatic vessels exiting in the canal