M: Living anatomy of the lower limb

Question 1

What does the gluteal fold mark?

Answer 1

The inferior border of gluteus maximus and the boundary between the gluteal and posterior thigh regions

Question 2

What muscles contribute to the quadriceps and which 3 are visible on the anterior surface of the thigh?

Answer 2

1) Rectus femoris
2) Vastus lateralis
3) Vastus medialis
4) Vastus intermedialis
Top 3 are visible on the anterior surface of the thigh

Question 3

Where does the iliac crest run from?

Answer 3

The anterior superior iliac spine to the posterior superior iliac spine

Question 4

Posterior superior iliac spines may be difficult to palpate as covered by fat, how else can they be located?

Answer 4

Located by permanent skin dimples lateral to the midline caused by the attachment of the overlying fascia to the PSIS

Question 5

A line joining the dimples marking the position of the PSIS passes through what?

Answer 5

The S2 spinous processes, the midline of the sacroiliac joints and bifurcation of the iliac arteries

Question 6

What structures within the vertebral column terminate at S2?

Answer 6

The arachnoid and dura mater

Question 7

What is the supracristal plane?

Answer 7

A line joining the highest points of the iliac crest which passes through the intervertebral disc between L4 and L5 vertebra

Question 8

What forms the base of the femoral triangle?

Answer 8

Inguinal ligament

Question 9

What forms the medial border of the femoral triangle?

Answer 9

Medial margin of adductor longus

Question 10

What forms the lateral border of the femoral triangle?

Answer 10

Medial margin of Sartorius muscle

Question 11

What forms the floor of the femoral triangle?

Answer 11

Formed medially by pectineus and adductor longus muscles and laterally by iliopsoas muscle

Question 12

Where does the apex of the femoral triangle point, what is it continuous with?

Answer 12

Points inferiorly

Continuous with the adductor canal

Question 13

What are the contents of the femoral triangle?

Answer 13

Femoral nerve, artery and vein and lymphatics

Question 14

What are the superomedial boundaries of the popliteal fossa?

Answer 14

Semimembranous and semitendinous

Question 15

What is the superolateral boundary of the popliteal fossa?

Answer 15

Biceps femoris

Question 16

What is the inferior border of the popliteal fossa?

Answer 16

Medial and lateral heads of gastrocnemius

Question 17

What are the contents of the popliteal fossa?

Answer 17

Popliteal artery and vein
Tibial nerve
Common fibular nerve

Question 18

Common fibula nerve wraps around what?

Answer 18

The neck of the fibula

Question 19

Which are the 4 pulse points in the limb which are used in clinical examinations?

Answer 19

1) Femoral pulse points
2) Popliteal pulse points
3) Posterior tibial pulse point
4) Dorsalis pedis pulse point

Question 20

Where is the femoral pulse point palpated?

Answer 20

Halfway between the ASIS and pubic tubercle, slightly inferior to the inguinal ligament

Question 21

What clinical procedures might be carried out on the femoral artery?

Answer 21

Angioplasty and stent placement

Coronary artery stenting

Question 22

Where can the popliteal artery be palpated?

Answer 22

In the popliteal fossa

Question 23

How can you aid palpation of the popliteal artery?

Answer 23

Flex the knee with the foot resting on the ground to relax hamstrings

Question 24

Where can the pulse of the posterior tibial artery be palpated?

Answer 24

Posterior to the medial malleolus

Question 25

Where can the dorsalis pedis artery be palpated?

Answer 25

Palpated lateral to the tendon of the extensor hallucis longus

Question 26

Why might it be necessary to palpate all the pulse points of the lower limb during an examination?

Answer 26

Any vascular stenosis can be identified, need to palpate all as it may be a distal narrowing

Question 27

Where do the superficial veins of the lower limb originate from?

Answer 27

From the dorsal venous arch of the foot

Question 28

What are the main superficial veins of the lower limb?

Answer 28

Great and small saphenous veins

Question 29

What is the course of the great saphenous vein?

Answer 29

From medial side of dorsal venous arch runs up medial side of leg, knee, thigh to pass through an opening in the deep fascia covering femoral triangle and join with the femoral vein

Question 30

What is the course of the small saphenous vein?

Answer 30

From lateral side of dorsal venous arch, passes behind the distal end of the fibula (lateral malleolus), and up the back of the leg to penetrate deep fascia and join the popliteal vein posterior to the knee

Question 31

What is the mechanism behind varicose veins?

Answer 31

Failure of venous valves allows blood to flow backwards down the veins and results in venous hypertension when standing - excess pressure leads to widening of veins, so valves don’t close properly. Blood flows back into leg along these veins and causes pooling and bulging

Question 32

Where is the best place to test the L3 dermatome?

Answer 32

Lower medial side of the thigh

Question 33

Where is the best place to test the L5 dermatome?

Answer 33

Medial side of digit 2

Question 34

How would you test mainly for the L3 and L4 myotomes?

Answer 34

Extension of the knee

Question 35

How would you test mainly for the S1 and S2 myotomes?

Answer 35

Plantar flexion of the foot

Question 36

What movement would you expect to occur when eliciting the knee reflex, what vertebral levels are being tested?

Answer 36

Extension of knee

L3,L4

Question 37

How would you test the knee reflex?

Answer 37

Patient sit on the couch with the leg dangling or the knee should be flexed and you should support the weight of the leg with the arm. The patellar ligament is tapped with the hammer halfway between the patellar and the tibial tuberosity

Question 38

How would you elicit the ankle reflex?

Answer 38

Push the foot into the dorsiflexed position and tap the calcaneal tendon superior to its insertion on the calcaneal bone

Question 39

What movements would you expect to occur when eliciting the ankle reflex, what vertebral levels are being tested?

Answer 39

Plantar flexion

S1 vertebral level