Midterm Flashcards
(337 cards)
1
Q
The femur and humerus are
A
long bones
2
Q
The carpal bones are
A
short bones
3
Q
The bones of the skull are
A
flat bones
4
Q
The bones of the face are
A
irregular bones
5
Q
The bones that develop in tendons such as the patella and pisiform are
A
sesamoid bones
6
Q
What do you call the spongy bone between the end of the diaphysis and the epiphysis?
A
metaphysis
7
Q
What is the highly neurovascular connective tissue that covers the bone called? What cells does it contain?
A
periosteum
osteoblasts
8
Q
What is the connective tissue lining the marrow cavity of the bone? What cells does it contain?
A
endosteum
osteoblasts
9
Q
What is at the end of the bone and is spongy bone surrounded by thin compact bone and contains the growth plate and epiphyseal plate?
A
epiphysis
10
Q
What do you call the shaft of the bone that is compact bone surrounding marrow cavity?
A
diaphysis
11
Q
What do you call where the epiphyseal plate fused and where is it located?
A
epiphyseal line
metaphysis
12
Q
What do yo cual bone that has an outer solid cortex which encloses an inner layer of spongy bone?
A
compact bone
13
Q
compact bone is ____
A
lamellar
14
Q
What do you call an inner layer of bone with spaces for bone marrow?
A
spongy bone
trabecular
cancellous
15
Q
spongy bone is _____
A
lamellar or woven
16
Q
What do you call mature or secondary bone? Most adult bone is this.
A
lamellar bone
17
Q
What is the arrangement of collagen fibers in lamellar bone?
A
regular parallel
18
Q
What do yo cual immature or primary bone? What is it usually replaced by?
A
woven bone
lamellar bone
19
Q
What is the arrangement of collagen fibers in woven bone?
A
loose
20
Q
Which has more cell lamellar or woven bone
A
woven!
21
Q
When does woven bone form?
Where can you always find it?
A
during fracture repair and remodeling, development
alveolar sockets and where tendons insert into bone
22
Q
What percent of bone is extracellular matrix? Water? Organic? Inorganic?
A
90%
10%
35%
65%
23
Q
What type of collagen fibers make up bone?
A
1
24
Q
What are the non collagenous proteins in bone and what are their functions?
A
osteocalcin- promotes osteoblasts
osteopontin- anchors osteoclasts
ostenectin
all three bind calcium
25
What inorganic material makes up the majority of mineralized bone?
calcium hydroxyapetite
26
What do you call the cells that support the bone matrix? Where do you find them?
osteocytes
| lacuna
27
What do you call the longitudinal vascular channels found in bones? What do they house and what are they the center of?
haversian canal
house capillaries and post-capillary venues
center of osteon
28
What do you call the transverse vascular channels? What do they connect?
Volkmann's canal
| Haversian canals
29
What are the two types of lamellae?
interstitial and circumferential
30
What type of lamellae is between osteons? What separates it from the osteon (also marks outer boundary of osteon)?
interstitial lamellae
| cement line
31
What is under the periosteum and is the external surface of compact bone?
outer circumferential lamellae
32
What is subjacent to the endosteum and is the internal surface of bone?
inner circumferential lamellae
33
How are collagen fibers arranged so that they prevent shearing forces and provide mechanical strength?
criss cross
34
What cells are rich in the inner layer of the periosteum? What's another name for this layer?
preosteoblasts (osteoprogenitor cells)
| osteogenic layer
35
What is the outer layer of the periosteum full of?
blood vessels and nerves
| fibroblasts and collagen fibers
36
What do you call the anchoring collagen fibers that penetrate the outer circumferential lamellae?
Sharpey's fibers
37
What covers spongy walls and where does it extend to? What cells are in here?
endosteum
extends into all cavities of bones (volkmanns and aversion)
osteoprogenitor cells, reticular stroll cells of bone marrow and connective tissue fibers
38
What do you call the precursors cells that self-replicate or differentiate into bone-forming cells? They are activated during growth, fracture, repair.
osteoprogenitor cells
39
What do you call bone-forming cells that deposit osteoid and control subsequent mineralization? What do they have high levels of?
osteoblast
| alkaline phosphatase
40
What do you call modified osteoblasts that become surrounded by newly formed bone?
osteocytes
41
What do you call macrophage-type cells that resorb bone in the remodeling process? What do they have high levels of? Where do the live?
osteoclast
acid phosphatase and collagenase
How ships lacuna
42
What is the disorder that is characterized by decreased mineralization of newly formed osteoid at sites of bone turnover (bone becomes soft)? What types of patients is this seen in?
osteomalacia
| ADULTS ONLY
43
What are causes of osteomalacia?
dietary vitamin D deficiency
lack of sun exposure
in the US: GI disease
44
What are signs and symptoms of osteomalacia?
```
bone and joint pain (WEIGH BEARING AREAS)
muscle weakness
fracture
difficulty walking and waddling gait
muscle spasms and cramps
```
45
What cells would be most affected by osteomalacia and why?
osteoblasts- they're in charge of mineralization of bone
46
```
What lab values would you expect in osteomalacia?
calcium
phosphorous
alkaline phosphatase
PTH
What about XRAYS!
```
decreased
decreased or normal
increased-osteoblasts are working hard
elevated to release calcium stored in bone
more pseudofractures/blackness
47
What type of osteogenesis uses mesenchymal template?
intramembranous ossification
48
What type of osteogenesis uses a cartilage template?
endochondral ossification
49
Frontal and parietal bones and part of the occipital, temporal, mandible, maxilla, and clavicle are all made via
intramembranous ossification
50
Portions of the basicranium, long bones, pelvic and pectoral girdles, and ribs are all made via
endochondral ossification
51
What are steps of intramembranous ossification?
1. condensation of mesenchyme permeated by capillaries
2. osteoblasts deposit osteoid on mesenchymal surface. entry osteocytes and begin forming periosteum
3. trabecular formed by mineral deposition- creation of spongy bone
4. surface bone filled in by bone deposition- compact bone. middle layer stays spongy
52
What are the steps of endochondral ossification?
1. mesenchyme becomes hyaline cartilage covered by perichondrium
2. perichondrium stops producing chondrocytes and starts producing osteoblasts. osteoblasts form thin collar of bone.
3. blood vessels penetrate bone collar and invade primary ossification centers
4. chondrocyte enlargement and death create secondary ossification center in epiphysis
5. epiphysis will fill with spongy bone and cartilage is limited to the epiphyseal plate
53
What creates the primary ossification center in endochondral ossification?
chondrocytes become enlarge and die
54
Why is there a wave of cartilage death that progresses to the end of the bones when blood vessels penetrate?
oxygen from blood turns cartilage to bone
55
Starting proximal to the middle of a long bone to distal what are the zones
```
zone of bone deposition
zone of calcification
zone of cell hypertrophy
zone of cell proliferation
zone of reserve cartilage
```
56
What do you call the disorder the is deficient mineralization of cartilage at the growth plate as well as architectural disruption of this structure? What patients is it ONLY seen in?
rickets
| children
57
What types of rickets is due to a calcium deficiency? What are causes?
cacipenic rickets
insufficient intake or metabolism of vit D
insufficient intake or absorption of calcium in the setting of normal vit D levels
58
What are signs of Rickets?
delayed closure of fontanelles
parietal and frontal bone bossing
craniotabes (soft skull bones)
widening of the wrist and bowing of the distal radius and ulna
progressive lateral bowing of the femur and tibia
59
What cells are most affected by rickets and why?
chondrocytes of growth plate in hypertrophic zone that are trying to mineralize stuff but can't
60
```
What lab values would you expect in calcipenic rickets?
calcium
phosphorous
alkaline phosphatase
pth
```
decreased
decreased
increased- you want to ossify areas but you can't
increased because you're trying to get calcium
61
What is the most common skeletal dysplasia that causes short-limb dwarfism? What bones are affected and which re spared?
achondroplasia
long bones
cranial and vertebral
62
What causes achondroplasia?
mutation in FGFR3 (fibroblast growth factor receptor 3) on chromosome 4
63
how does the mutation in FGFR3 lead to dwarfism?
mutation is GOF so overactive stop signal
inhibits cartilage synthesis resulting in decreased endochondral ossification and premature ossification of growth plates
64
What zone of endochondral ossification is most affected by achondroplasia?
proliferation zone
65
How do you convert a trabeculae to osteon?
1. ridge in periosteum create groove for periosteal blood vessel
2. ridge fuse forming an endosteum lined tunnel
3. osteoblasts in endo build lamellae inward toward center of tunnel forming an osteon
4. bone grows outward as osteoblasts in periosteum build new circumferential lamellae
66
What are the steps for bone remodeling?
1. osteoclast precursors show up in haversian canal and become osteoclasts and line bone lamellae
2. osteoclasts resorb the bone osteoblasts show up when they're done
3. osteoblasts organize a layer inside resorption cavity and secrete osteoid. cement line indicates boundary of new lamellae.
4. osteoblasts do they're work until they're trapped and become osteocytes. new osteon/haversian system is formed leaving behind interstitial lamellae
67
What is characterized by low bone mass, micro architectural disruption, skeletal fragility, resulting in decreased bone strength and an increased risk of fracture?
osteoporosis
68
What are signs of osteoporosis?
none until there is a fracture
69
```
What cells are affected by osteoporosis?
What lab values do you expect?
calcium
phosphorous
alkaline phosphatase
```
osteoclast activity outpaces osteoblast activity because they're overstimulated for whatever reason
all labs are normal
70
What are the steps in healing a bone fracture?
1. hematoma/inflammatory phase
2. cartilage is formed and soft callus contributes to the stability of the bone fractured ends. woven bone, in the form of trabeculae, gradually replaces cartilage. mineralization of woven bone.
3. osteoblasts activate. hard callus formation.
4. osteoclasts reabsorb excessive and misplaced trabeculae and new bone is laid by osteoblasts to construct compact bone. new aversion systems and osteons are formed.
71
How does cartilage differ from bone?
avascular no nerve supply or lymphatics
72
What cells are the replicating population that secrete cartilaginous matrix?
chondroblasts
73
What cells maintain the matrix of cartilage?
chondrocytes
74
What makes up cartilage matrix?
```
type 2 collagen
ground substance (same as in bone)
aggrecan
```
75
What things make up ground substance in both bone and cartilage?
hyaluronic acid, chondroitin sulfate, keratan sulfate
76
What is the function of aggrecan?
resists compression
77
what are the three types of cartilage
fibrocartilage
hyaline
elastic
78
What type of cartilage is surrounded by perichondrium and is found in embryo, articular cartilage, cartilage of respiratory tract, and costal cartilage?
hyaline
79
What cartilage is surrounded by perichondrium and is found in external ear, epiglottis, and auditory tube?
elastic
80
What types of cartilage are surrounded by territorial and inter territorial matrices containing type II collagen? Which one has elastic fibers?
hyaline and elastic
| elastic
81
What type of cartilage lacks perichondrium, has type I collagen surrounding chondrocytes and fibroblasts, and is found in intervertebral disks, articular disks of the knee, mandible, SC joints, and pubic symphysis?
fibrocartilage
82
What do you call dense connective tissue that interferes around hyaline and elastic cartilage? What does it carry? What is the source of?
perichondrium
carries blood supply for avascular cartilage
new cartilage cells
83
What layer contains fibroblasts and produces type I collagen and elastin?
outer fibrous layer
84
What are round cells with small dark nuclei that are arranged in lacunae often in groups of 2-8 cells? What do you call these groups?
chondrocytes
| isogenous groups
85
What layer gives rise to chondroblasts and osteoprogenitor cells? What do the chondroblasts secrete?
inner chondrogenic layer
| type II collagen
86
What surrounds isogenous groups and has a high amount of GAGs and lower amount of collagen?
territorial matrix
87
What surrounds the territorial matrix and has more collagen II and fewer proteoglycans?
interterritorial matrix
88
Hyaline cartilage is surrounded by and nourished by perichondrium except for where?!?!?!?
articular surfaces
89
What is the temporary skeleton in the embryo? Where else do you find this?
hyaline cartilage
| epiphyseal plates
90
What do you use to stain elastic fibers?
resorcin-fuchsin and orcein
91
What type of cartilage is characterized by increased flexibility and returns to original shape after deformation?
elastic cartilage what a champ
92
What type of collagen fibers do you find in fibrocartilage and how are they arranged?
type I and II
| arranged in more or less regular fashion between rows of cells
93
What does the ground substance of fibrocartilage have?
derma tan and chondroitin sulfate
94
What may develop as a result of damage to hyaline cartilage
fibrocartilage
95
Where does interstitial growth occur? What increases the mass of cartilage?
chondrocytes divide within lacuna- within cartilage mass itself
chondrocytes secrete more matrix which increases mass
96
What limits interstitial growth?
avascular nature
97
Where does appositional growth happen?
on the surface of pre-existing cartilage
98
Within what layer and by what cells does appositional growth happen? What do these cells produce?
within inner layer of perichondrium
| chondrogenic cells produce collagen I and become chondroblasts and secrete collagen II and ground substances
99
What is primarily in charge of repairing cartilage?
perichondrium
100
When cartilage is damaged what is it usually replaced by?
dense connective tissue or bone (if vascularized)
101
In adults, proliferation of perichondrium usually results in formation of????
dense CT
102
Why does proximity for blood vessels often stimulate bone growth instead of cartilage repair?
high oxygen tensions which produces osteoblasts
103
What are the three types of joints and examples of each!
synarthroses: permit little to no movement (cranial bones, ribs, sternum)
amphiarthroses: enable slight movement (intervertebral disks and bodies
diarthroses: permit free movement (synovial joints)
104
What is the fibrous capsule that is usually strengthened by accessory ligaments?
articular capsule in synovial joints
105
What are the two types of ligaments that strengthen articular capsules?
intrinsic- part of fibrous capsule
| extrinsic- separate from the capsule
106
What lines the entire synovial joint cavity except the articular cartilage? What does it produce? Does it regenerate if damaged?
synovial membrane
synovial fluid
yes
107
What is on the end of bones and reduces the friction between them in synovial joints? What does it not have in synovial joints?
hyaline cartilage
| no perichondrium
108
What are the two types of synovial cells?
type A macrophage
| type B fibroblast
109
What protein do type B synovial cells produce that lubricates cartilage to reduce friction?
lubricin
110
What layer in articular cartilage has small chondrocytes that are flattened to the surface? How do the collagen fibers run in this layer?
tangential layer
| parallel
111
What layer in articular cartilage has slightly larger rounder chondrocytes that are both single or in isogenous groups? What course do collage fibers take here?
transitional layer
| oblique course
112
What layer in articular cartilage has large chondrocytes that form radial columns? what is the course of the collagen fibers here?
radial layer
| follows orientation of the chondrocyte columns
113
What layer of articular cartilage rests on the underlying context of the bone and stains slightly darker than other layers?
calcified cartilage
114
What disorder is a result of lose/damaged articular cartilage? S/s are pain (alleviated via rest), tenderness, limitation of motion, bony swelling, joint deformity, instability.
osteoarthritis
115
What all EXITS through the greater sciatic foramen?
- gluteal neuromuscular bundles
- piriformis m.
- sciatic nerve
- posterior femoral cutaneous n.
- pudendal n. and internal pudendal a.
- obturator internus/superior gemellus n.
116
What all EXITS through the lesser sciatic foramen?
obturator internus
117
what all ENTERS through the lesser sciatic foramen?
- pudendal n. and internal pudendal artery
| - obturator internus/superior gemellus nerve
118
What are the cutaneous gluteal nerves?
cluneal nerves
superior and middle:
-lateral branches of DORSAL rami (L1-L3, S1-S3) supply superior 2/3, sacrum, and adjacent area
inferior:
-gluteal branches of posterior femoral cutaneous nerve (s1-s3 VENTRAL rami branches) supply inferior 1/3
119
What are the deep nerves of the gluteal region?
Superior and inferior gluteal nerves
120
Describe the path of the superior gluteal nerve
| what muscles does it work for
leaves pelvis superior to piriformis with superior gluteal artery
runs between gluteus medius and gluteus minimus
supplies gluteus medius, gluteus minimus, tensor fasciae latae
121
Describe the path of the inferior gluteal nerve
| what muscle does it work for
leaves pelvis inferior to piriformis with inferior gluteal artery
supplies gluteus maximus
122
What is the largest nerve in the body and what is its origin
sciatic nerve
| L4-S3
123
Describe the path of the sciatic nerve
what does it split into
does it supply gluteal structures
leaves pelvis inferior to piriformis
runs inferiorly dip to gluteus maximus
divides about half way down thigh into tibial and common fibular nerves
NO
124
Posterior hip dislocation can cause damage to what nerve? What is the clinical presentation of this nerve damage?
sciatic nerve
paralysis of hamstrings and muscles distal to the knee
sensory change may occur in skin over the posterolateral aspects of leg and most of the foot
125
What nerve supplies more skin than any other cutaneous nerve
posterior femoral cutaneous nerve
126
What nerves supply the small lateral rotators of the gluteal region?
quadratus femoris- inferior gemellus nerve
| obturator internus- superior gemellus nerve
127
what is the path of the superior gemellus nerve and what muscle does it supply?
leaves pelvis via greater sciatic foramen and reenters pelvis via lesser sciatic foramen
obturator internus
128
What ramis does the pudendal nerve come from?
anterior divisions of S2-S4 ventral rami
129
Describe the path of the pudendal nerve and what does it supply
most medial structure exiting greater sciatic foramen renters pelvis via lesser sciatic foramen to supply perineal structures
130
What are the branches that arise from the internal iliac artery?
superior gluteal artery
inferior gluteal artery
internal pudendal artery
131
What is the largest branch of the internal iliac artery? What do its branches supply?
superior gluteal artery
superficial branch: gluteus maximus
deep branch: gluteus medium, minimum, tensor fascia lata
132
What does the inferior gluteal artery branch from? What does it supply?
internal iliac artery
| gluteus maximus, small lateral rotators, superior hamstrings
133
What arteries participate in the cruciate anastomosis of the thigh
inferior gluteal artery
transverse branch of the medial circumflex femoral artery
terminal part of the transverse branch of the lateral circumflex femoral artery
first perforating artery
134
What provides blood to the leg if the femoral artery is occluded or severed?
cruciate anastomosis
135
What does the internal pudendal artery branch from? Describe its path and what it supplies
internal iliac artery
reenters pelvis via lesser sciatic foramen with pudendal nerve
supplies perineal muscles and external genitalia
NO gluteal structures
136
Where should intragluteal injections be done? What are you trying to avoid?
supers-lateral part of gluteal region
| avoid sciatic nerve and other gluteal nerves/vessels
137
What is the chief extensor of the thigh and lateral rotation? What nerve innervates it?
gluteus maximus
| inferior gluteal nerve
138
How does the gluteus maximus help with leg extension?
just a little bit of help via tensor fascia lata
139
What part of the os coxae does the gluteus maximus attach to?
posterior gluteal line
140
What muscles are in charge of thigh abduction and medial rotation? What nerves supply them?
gluteus medius and minimus (particular medial rotation)
| superior gluteal nerve
141
What are the functions of the tensor fascia late and who innervates him?!
-abducts, medially rotates, flexes thigh (some leg extension w/glut max)
superior gluteal nerve
142
What are the many functions of the IT band?
- assists in decelerating adduction of thigh
- laterally stabilizes knee
- extends leg, compensate for quadriceps paralysis via glut max flexion
- pulls patella laterally, antagonist of vastus medals, and synergist with flexing vests lateralis for this action
- stretch to treat chondromalacia patella
143
What does a positive trendelenburg's sign indicate? What is the effect?
superior gluteal nerve injury
patient loses steadying action of gluteus medium and minimus
lean toward EFFECTED side during stance phase of gate
144
Describe the location of the piriformis
lies deep to gluteus maximus and medial to gluteus medius
145
Describe the location of the obturator externes and the nerve that innervates it
deep to pectinous
attaches to external margins of obturator foramen and trochanteric fossa
innervated by obturator nerve
146
What do you call groups of muscle fibers bundled together?
fasciculus
147
What covers the fasciculus?
perimysium
148
What is around the periphery of muscles and binds all the fascicles together?
epimysium
149
What is the histology of skeletal muscle
striated and non-branching
peripheral nuclei
lots of cytoplasm
150
What is the plasma membrane of muscle fibers? What is it surrounded by?
sarcolemma
| basal lamina and satellite cells
151
What do you call the cytoplasm of muscle fibers?
sarcoplasm
152
What do muscle fibers use for energy? for binding oxygen? produces ATP for energy?
glycogen
myoglobin
mitochondria
153
What do you call the invaginations of the sarcolemma?
transverse (t) tubules
154
What encircles each myofibril? What does it store?
sarcoplasmic reticulum
| calcium
155
What are dilated ends of sarcoplasmic reticulum called? What do they release? What do they trigger?
terminal cisterns
release calcium
trigger muscle contraction
156
What makes up a muscle fiber triad? Where is it found?
one t-tubule and two terminal cisterns
| found at the A-I junction
157
What are the contractile elements of muscle?
myofibrils
158
What are the components of the myofibrils?
thick and thin filaments
159
What are the basic functional units of a myofibril?
sarcomere
160
What do you call the band that extends the entire length of the thick filaments?
A band
161
What band contains thin filaments?
I band
162
What separates one sarcomere from the next and passes through the I band?
Z disk (band or line)
163
What band contains only thick filaments and is in the center of the A band?
H band (zone)
164
What is the middle of the sarcomere?
M line
165
what is the contractile protein that is the main component of thin filament and is assembled from G-actin?
F-actin
166
What is the contractile proteins in thick filaments and hast ATPase activity? What does it bind?
myosin II
| actin
167
What are the two types of contractile proteins?
myosin and F-actin
168
What are the regulatory proteins that run in groove formed by F-actin strands? What does it bind to?
tropomyosin
| troponin complex
169
What are the three types of troponin and what do they do?
T- binds the complex to tropomyosin
I-inhibits the binding of myosin to actin
C- binds calcium
170
What are the regulatory muscle proteins?
tropomyosin and troponin
171
What are the structural muscle proteins?
nebulin and titin
172
What is the large protein associated with F-actin and inserts into the Z disk and acts as a stabilizer for maintaining the length of F-actin?
nebulin
173
What is th large structural protein associated with myosin? Where does it stretch from?
titian
| stretches from Z disk to M line
174
What does titian control? regulate? limit?
controls assembly of thick myofilaments by acting as a template
regulates sarcomere elasticity
limits displacement range of the sarcomere in tension
175
What structural protein forms the M line?
myomesin
176
What structural proteins maintain the mechanical integrity of the contractile apparatus? What does it link?
design
| links myofibrils to sarcolemma
177
What is the heat shock protein that protects design from stress-induced damage?
aB-crystallin
178
What is the cytoskeletal protein that links filaments to integral proteins of sarcolemma?
dystrophin
179
Where do you find nerve fibers and capillaries for muscle cells?
in the endomysium between individual cells
180
What type of fiber is "red", slow twitch, fatigue resistant?
type I
181
What type of fiber is "white", fast twitch, fatigue more easily?
type II
182
What type of fiber is high in myosin ATPase activity?
type IIB
183
What type of fibers are more intermediate types of fibers?
type IIA
184
What type of mesoderm gives rise to myotome, sclerotome, and dermatome?
paraxial
185
What do you call the somites that give rise to the axial skeleton?
sclerotome
186
What type of mesoderm gives rise to the kidneys and genitals?
intermediate
187
What type of mesoderm gives rise to the connective tissue (blood, lymph, mesenteries, cardiovascular)?
lateral plate!
188
What part of the somite gives rise tot he sclerotome?
ventromedial part
189
What part of the somite gives rise to the dermatome and myotome?
dorsolateral part
190
What are the key components of the developing vertebral column?
notochord and paraxial mesoderm
191
What are the two parts of the sclerotome in the vertebral column?
caudal dense part
| cephalic loose part
192
How do the sclerotomes fuse with each other to form the vertebral column?
caudal 1/2 of sclerotome A uses with the cephalic 1/2 of sclerotome B
193
What does the notochord extend to form in the intervertebral discs?
nucleus pulposus
194
What is the fibrous tissue from the sclerotome in the intervertebral discs? What kind of cartilage is it?
annulus fibrous
| fibrocartilage
195
What do sclerotome cells that grow out from costal process of thoracic vertebra become?
ribs
196
What does costal cartilage come from?
sclerotome
197
What develops in the somatic lateral plate mesoderm?
sternum
198
What do you call it when the sternum protrudes? Also called pigeon chest
precuts crainatum
199
What abnormality contributes to thoracic outlet syndrome?
cervical ribs
200
What do you call a sternum depression?
precuts excavatum
201
What derivative from myotomes give rise to epaxial muscles? What are they innervated by?
epaxial muscles
| dorsal rami
202
What derivative from myotomes give rise to hypaxial muscles? What are they innervated by?
hypaxial muscles
| ventral rami
203
What division of muscles form extensor muscles of neck and vertebral column?
epaxial divisions
204
What syndrome is associated with syndactyly, absence of pec major and minor, ipsilateral breast hypoplasia and absence of 2-4 ribs?
poland syndrome
205
What syndrome is associated with partial or complete absence of abdominal musculature? What else is there a malformation of?
prune-belly syndrome
cryptorchidism (failure of 1 or 2 testes to drop)
malformation of urinary tract and bladder, urethral obstruction
206
What are the floor and roof of the femoral triangle?
floor- pectinous and iliopsoas muscles
| roof- fascia lata
207
What are the base, lateral wall, and medial wall of the femoral triangle?
base- inguinal ligament
lateral wall- sartorial
medial wall- adductor longus
208
The femoral triangle is an inferior prolongation of what?
transversals fascia
209
What is the function of the femoral sheath?
allows femoral vessels to glide smoothly deep to inguinal ligament during hip joint movements
210
Where does the femoral sheath end? What is it continuous with?
4-10cm distal to inguinal ligament
| continuous with loose connective tissue covering femoral vessels
211
What do the two vertical septa divide the femoral sheath into?
three compartments:
lateral (femoral artery)
intermediate (femoral vein)
medial or femoral canal
212
What does the femoral sheath NOT contain?
femoral nerve
213
What do you call the proximal opening of the femoral canal that is 1cm wide? What is it covered by?
femoral ring
| parietal peritoneum
214
What do you call it when a loop of small intestine can protrude into the femoral canal and come out the femoral ring?
femoral hernia
215
What type of hernia travels down the entire inguinal canal and may extend all the way into the scrotum?
indirect inguinal hernia
216
What type of hernia protrudes through the superficial inguinal ring and creates a bulge in the lower anterior abdominal wall?
direct inguinal canal
217
What type of inguinal is lateral to inferior epigastric vessels and deep inguinal ring? What patients do you usually see this in?
indirect inguinal hernia
younger males
congenital
218
What type of hernia passes medial to inferior epigastric vessels and punches through peritoneum and transversals fascia?
usually acquired
direct inguinal hernia
seen in females too
219
Why do women more commonly develop femoral hernias?
greater width of their femoral triangle
220
What lymph nodes drain lymph from lower limb, including gluteal region, perineum and parts of anal canal, and anterior abdominal wall (up to umbilicus)?
inguinal lymph nodes
221
What are the two groups of inguinal lymph nodes?
superficial and deep inguinal lymph nodes
222
What are the two types of superficial inguinal lymph nodes?
proximal (horizontal) group
| distal (vertical) group
223
What do the distal group of superficial lymph nodes lay next to?
great saphenous vein
224
What do the superficial inguinal lymph nodes pass underneath? What do they drain into?
deep to inguinal ligament
| drain into external iliac lymph nodes
225
What do the deep inguinal lymph nodes lay next to? What are they inside? What do they drain into?
medial side of femoral vein
inside femoral canal of femoral sheath
external iliac lymph nodes
226
What are the roots of the femoral nerve?
L2-L4
227
What muscles does the femoral nerve supply?
iliac
sartorius
quadriceps femori
pectineus
228
What is the cutaneous branch of the femoral nerve?
saphenous nerve
229
What branch of what nerve does cutaneous innervation of the anterior thigh including the knee?
anterior (intermediate and medial) cutaneous branches of femoral nerve
230
What nerve does cutaneous innervation of the medial calf including medial malleolus and medial side of knee?
saphenous nerve from femoral nerve
231
What nerve does cutaneous innervation of lateral thigh?
lateral femoral cutaneous nerve from femoral nerve
232
Due to limb rotation more lumbar contributions are visible ____ and sacral ____ posteriorly for dermatomes.
anteriorly
| posteriorly
233
What nerve may be affected by anterior hip dislocation? What do you call the resulting problem?
femoral nerve and lateral femoral cutaneous nerve
| meralgia paresthetica
234
What do you call the resulting issue from the compression of the lateral femoral cutaneous nerve as it passes under inguinal ligament causing pain along lateral thigh?
meralgia paresthetica
235
What nerve becomes superficial between the sartorial and gracilis? It passes anteroom-inferiorly with what vein?
saphenous nerve
| great saphenous vein
236
What nerve supplies anterior and medial knee and leg and the medial foot?
saphenous nerve
237
Where does the adductor canal begin and end?
begins at apex of femoral triangle
| ends at adductor hiatus
238
What do you call the opening in tendon of adductor magnus that allows femoral vessels to reach popliteal fossa via this archway?
adductor hiatus
239
What artery provides the chief arterial supply to the lower limb?
femoral artery
240
Where does the femoral artery enter into the femoral triangle?
deep to midpoint of inguinal ligament
| lateral to femoral vein
241
What is the course of the femoral artery?
descends on iliopsoas, pectinous, and adductor longs muscles
| bisects apex deep to sartorius
242
Inferiorly in thigh, the femoral artery gives rise to what? What are the two branches?
descending genicular artery
| articular branch and saphenous branch
243
Where can you palpate the femoral artery? What lies posterior to it?
2-3cm inferior to midpoint of inguinal ligament midway between ASIS and pubic tubercle
femur head lies posterior
244
What is the largest branch of the femoral artery? What is it the chief arterial supply for?
profunda femoris a.
| chief artery to thigh
245
What does the profunda femoral a. descend behind? In the femoral triangle what does it give rise?
adductor longus
| gives rise to medial and lateral circumflex femoral arteries
246
What artery is the main supply to femoral head and neck?
medial circumflex femoral artery
247
What does the medial circumflex femoral artery pass between to reach the posterior thigh?
ilipsoas and pectineus
248
What does the does the lateral circumflex femoral artery pass laterally and deep to? What does it supply?
sartorius and rectus femoris
| supplies lateral thigh muscles and femur head
249
What are the three named branches of the lateral circumflex femoral artery?
ascending, transverse, and descending
250
What arteries supply the adductors (particularly adductor magnus) and hamstring muscles?
perforating arteries of deep femoral artery
251
What does the femoral vein lie deep to in the apex of the femoral triangle?
femoral artery
252
How can you access the venous system via the great saphenous vein?
incision may be made anterior to medial malleolus "saphenous cutdown"
253
Why will a patient complain of pain along medial border of foot as a result of a saphenous cutdown?
hit the saphenous nerve
254
What are the nerve roots of the femoral nerve?
L2-L4
255
What are the nerve roots of the obturator nerve?
L2-L4
256
What are the nerve roots of the sciatic nerve?
L4-S3
257
What are the nerve roots of the tibial nerve?
L4-S3
258
What are the nerve roots of the common fibular nerve
L4-S2
259
What nerve and spinal cord segments does the patellar tendon reflex test for? The absence/decrease of this reflex is down as?
femoral nerve L2-L4
| Westphal's sign
260
What nerve roots does the calcaneal tendon reflex txt for? What must've happened to the nerve root if the reflex is absent?
S1 and S2
| cut or compressed
261
What is the chief flexor of the thigh?
ilipsoas m.
262
What nerve supplies the iliacus?
femoral nerve
263
What rami supplies the psoas major? Psoas minor?
L1-L3 ventral rami
| L1-L2 ventral rami
264
What bursa does the iliopsoas glide over?
iliopectineal bursa
265
What is the longest muscle in the body? Also the most superficial anterior muscle.
sartorius!
266
What nerve innervates the sartorius? What are the functions?
femoral nerve
flex, abduct, laterally rotate thigh
flex leg
267
What do you call the spot where the sartorius tendon, gracilis tendon, and semitendinosus tendon insert?
pes anserinus
268
What three muscles insert on the pes anserinus?
sartorius
gracilis
semitendinosus
269
What bursas are under the the semimembranosus and pes anserinus?
bursa of semimembranosus
| anserine bursa
270
What nerve innervates the quadriceps femoris? What are the functions?
femoral nerve
vasti extend leg
rectus extends leg and flexes thigh
271
What kind of activities result in Osgood-Schlatter Disease? What is the main finding that indicates Osgood-Schlatter disease?
lots of running, jumping, bending. ballet volleyball ballet soccer
new bone growth (lump) on tibia
272
Why is there new bone growth in Osgood-Schlatter Disease?
child's quads pull on tendon that connects knee cap to the shinbone. causes the tendon to pull away from the shinbone a bit resulting in pain and swelling.
273
Tendons of all four quadriceps unite to form the? Which continues inferiorly as the?
quadriceps tendon
| patellar ligament
274
What are the superficial medial thigh muscles (adductors)?
pectineus, adductor longus, adductor brevis, gracilis
275
What are the deep medial thigh muscles?
adductor magnus (adductor and hamstring portions) and obturator externus
276
What are the attachments of the pectineus m.?
```
pecten line of pubis (origin)
pectineal line (insertion)
```
277
What nerve innervates the pectineus m?
femoral nerve (occasionally a branch from the obturator n)
278
What are the functions of the pectineus m?
adduct and flex thigh
279
What are the attachments of the adductor longus?
body of pubis (inferior to pubic crest)
| middle 1/3 of linea aspera
280
What innervates the adductor longus m? What are the functions?
```
obturator nerve (L2-L4)
adducts and flexes thigh
```
281
What is the only adductor to cross the knee joint?
gracilis
282
What are the attachments of the gracilis?
pubis body and inferior rams
| superior part of medial surface of tibia (part of pet anserinus)
283
What innervates the gracilis and what are the functions?
obturator nerve
adduct thigh
flex and medially rotate leg
284
What muscle lies deep to the pectineus and adductor longus
adductor brevis
285
What are the attachments of the adductor brevis?
pubis body and inferior rams
| proximal linea aspera
286
What innervates the adductor brevis? What are the functions?
obturator nerve
| adducts and flexes thigh
287
When someone has a groin pull, there's a strain stretching or probably some tearing of what?
proximal attachments of thigh adductor/flexor muscles
288
What does the obturator externus lie deep to? What are the attachments?
pectineus
external margins of obturator foramen
trochanteric fossa
289
What innervates the obturator externus?
obturator nerve
290
What is the largest adductor muscle? What are the two portions?
adductor magnus
adductor portion
hamstring portion
291
What are the origins of the hamstring and adductor parts of the adductor magnus?
hamstring- ischial tuberosity
| adductor- ischiopubic ramus
292
What is the distal attachment and functions of the adductor part of the adductor magnus? Nerve?
gluteal tuberosity, linea aspera, medial supracondylar line
obturator nerve
adducts and flexes thigh
293
What is the distal attachment of the hamstring part of the adductor magnus? Nerve? Function?
adductor tubercle (medial epicondyle)
tibial division of sciatic nerve
adducts and extends thigh
294
What are the three general thigh compartments and the nerves that innervate them?
anterior- extension and femoral nerve
medial- adduction and obturator nerve
posterior- flexion and sciatic nerve
295
A joint is innervated by the very same nerves that supply the muscles that move the joint and supply the skin over the joint. Whose law?
hilton's law
296
What anastomoses does the leg use when the knee is bent and the popliteal artery is kinked?
genicular anastomoses
297
What arteries are involved in the genicular anastomoses?
superior later, inferior lateral, superior medial, middle genicular artery
298
What is the common proximal attachment of the posterior thigh muscles?
ischial tuberosity except for the short head of the biceps femoris
299
What is the common innervation of the posterior thigh muscles?
tibial division of sciatic nerve
| except short head of biceps femurs which is the common fibular portion
300
What are the functions of the posterior thigh muscles?
thigh extension except short head of biceps femurs
| leg flexion for all four
301
What are the posterior thigh muscles?
semitendinosus, semimembranosus, biceps femoris long and short heads
302
What is the function of the semitendinosus? Innervation?
extend thigh, flex leg, med rotate
| tibial division of sciatic nerve
303
What are the attachments of the semitendinosus?
ischial tuberosity
| medial surface of superior aspect of tibia
304
What are the three muscles that insert on the pes anserinus and the nerves that innervate them?
gracilis- obturator n
semitendinosus- tibial division of sciatic n
sartorius- femoral n
305
What are the functions of the semimembranosus and the innervation?
extend thigh, flex leg
| tibial division of sciatic nerve
306
What are the attachments of the semimembranosus?
```
ischial tuberosity (flattened membranous proximal attachment)
posterior part of medial condyle of tibia
```
307
The distal tendon of the semimembranosus divides into what two parts?
medial tibial condyle and part blends with popliteal fascia and becomes oblique popliteal ligament
308
What is the point of the semimembranosus distal tendon blending with popliteal fascia and becoming the oblique popliteal ligament?
reinforces intercondylar part of joint capsule of knee
309
What is the function of the long head of the biceps femoris and the innervation?
flex leg, extend thigh
| tibial division of sciatic nerve
310
What ist he function of the short head of the biceps femoris and the innervation?
only flexed leg
| common fibular branch of the sciatic nerve
311
What are the attachments of the two heads of the biceps femoris?
long head- ischial tuberosity
| short head- distal lateral lip of linea aspera
312
What is the common insertion of the biceps femoris?
head of the fibula
313
What are the attachments of the adductor magnus hamstring portion?
ischial tuberosity and adductor tubercle on the medial epicondyle of the femur
314
What is the function and innervation of the hamstring portion of the adductor magnus?
extend thigh
| tibial division of sciatic nerve
315
What are the boundaries of the popliteal fossa?
superomedially- semitendinosus and semimembranosus
superolaterally- biceps femoris
inferolaterally- lateral head of gastrocnemius
inferomedially- medial head of gastrocnemius
316
What are the contents of the popliteal fossa superficial to deep?
nerves
popliteal vein, lymph nodes and branches
popliteal artery and branches
317
What is the deepest structure of the popliteal fossa? What is it a continuation of?
popliteal artery
| femoral artery
318
When does the femoral artery becomes the popliteal artery?
after passing through adductor hiatus
319
The popliteal artery gives rise to what branches?
genicular branches
320
What supplies the articular capsule and ligaments of the knee joint?
genicular branches
321
When the popliteal artery terminates, what does it divide into?
anterior tibial artery
| posterior tibial artery
322
The popliteal vein is formed by the union of what? Usually near what?
anterior and posterior tibial veins
| inferior border of popliteus muscle
323
The small saphenous vein terminates into the?
popliteal vein
324
The popliteal vein lies superior to and and in the same fibrous sheath as the? What does it become after traversing adductor hiatus?
popliteal artery
| femoral vein
325
The popliteal vein becomes the femoral vein after traversing what?
adductor hiatus
326
What does the sciatic nerve divide into? Where?
tibial nerve and common fibular (perineal) nerve
| superior angle of popliteal fossa
327
What is the most superficial structure compared to the popliteal artery and vein in the popliteal fossa?
tibial nerve
328
What does the tibial nerve innervate?
superficial and deep posterior leg muscles
| knee joint
329
How does the common fibular (peroneal) nerve leave the popliteal fossa?
passes superficial to lateral head of gastrocnemius
330
Why is the common fibular nerve susceptible to injury?
it winds around the head and neck of fibula
331
What does the common fibular nerve terminate into? Where?
deep fibular nerve and superficial fibular nerve
| deep to fibularis longus
332
What nerve supplies distal posterior aspect of the leg and lateral aspect of ankle and foot
sural nerve
333
What ist he sural nerve composed of?
medial sural cutaneous nerve from tibial nerve
| sural (or fibular) communicating branch from the common fibular nerve or the lateral rural cutaneous nerve
334
What does the rural nerve run with?
saphenous vein
335
xiphoid process
T7
336
groin
L1
337
perineum
S1
