Review of lower limb Flashcards

(123 cards)

1
Q

Shenton’s line is between which two areas of the hip joint? [2]

A

Superior pubic ramus - inferomedial border of the neck offemur

L has neck of femur fracture: shenton line not normal

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2
Q

The hip joint’s stability is increased by which three ligaments [3]

Which is the strongest? [1] - Why is this clinically significant? [1]

A

Pubo-femoral ligament
Ilio-femoral ligament- strongest & found on anterior aspect of the joint - so anterior more strong than posterior
Ischio-femoral ligament

Together - they push the head of the femur into the hip

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3
Q

Which is the ligament found within the hip joint that strengthens the joint? [1]

A

Ligamentum teres

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4
Q

Describe the blood supply to the head and neck of femur [

A

Profunda femoris: give off medial and lateral circumflex arteries
- from these two arteries get Retinacular arteries- majority of blood to head and neck

Obturator artery: Artery to the head of the femur

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5
Q

The obturator artery is important for which patient population & why? [2]

A

Paedatric population: important for ossification for head of femur

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6
Q

line things

A
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7
Q

Which qudrant do you used for IM injection?

A
B
C
D

A

Which qudrant do you used for IM injection?

A - avoid sciatic nerve
B
C
D

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8
Q

nerve supply in the pelvis

A
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9
Q

Gluteus maximis inserts onto which structure? [1]

Which nerve supplies gluteus maximus? [1]

A

Inserts onto iliotibial band

Supplied by inferior gluteal nerve

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10
Q

Which nerve supplies gluteus medius and minimus? [1]

What movement do they cause? [1]

A

Superior gluteal nerve

Hip abduct and internally rotate the thigh

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11
Q

Tensor fascia lata

A
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12
Q

Lateral rotators

A
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13
Q

How do gluteus minimus and medius work to provide hip stablity? [1]

How does gluteus minimus and medius damage present? [1]

A

Opposite side contract when you walk to stop hip dropping,

Damage to them causes contralateral hip drop / Positive Trendelenburg test

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14
Q

thigh compartments

A
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15
Q

Sciatic nerve

A
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16
Q

What are the borders of the femoral triangle? [3]

A

Superior border: inguinal ligament

Lateral border – medial border of the sartorius muscle.

Medial border medial border of the adductor longus muscle. The rest of this muscle forms part of the floor of the triangle.

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17
Q

Order of neurovascular in femoral triangle? [4]

A

NAVL:

Nerve
Artery
Vein
Lymphatics

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18
Q

What are the borders of the popliteal fossa? [3]

A

Medial superior: semimembranosus and semitendinosus

Medial inferior: Gastrocnemius

Medial lateral: bicep femoris

Medial inferior: Gastrocnemius

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19
Q

After leading the popliteal artery

  • what is the anteiror segment?
  • what is the lateral sgement?
  • what is the posterior segment?
A

Anterior
* anterior tibial: dorsalis pedis

Lateral
* perforating branches of deep penoneal (fibular)

Posterior
* posterior tibial: medial and lateral plantar

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20
Q

Neck of femur fractures (typically with significant displacement) will classically present with a [] and [] rotated limb.

A

Neck of femur fractures (typically with significant displacement) will classically present with a shortened and externally rotated limb.

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21
Q

NICE recommends offering total hip replacement over hemiarthroplasty in patients whom are [3]

A
  • Able to walk independently outdoors with no more that one stick
  • Not cognitively impaired
  • Medically fit for the operation
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22
Q

Which muscle is responsible for shortening of the limb and external rotation following a NoF fracture? [1]

A

Iliopsoas

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23
Q

Common complication of posterior hip dislocation? [1]

A

Sciatic nerve involvement

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24
Q

Presentation of patellar dislocation? [1]

A

Knee held in flexion

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25
How to reduce a patellar dislocation? [1]
Push patella medially whilst extending knee
26
Structures at risk in an anterior dislocation of the tibiofemoral joint? [3]
Popliteal artery Tibial nerve Common peroneal nerve
27
In which direction is the patella usually dislocated? [1]
Laterally due to pull of quadriceps
28
What is a bimalleolar fracture (Pott's fracture)? [1]
fracture involving the lateral and medial ankle
29
Explain which malleolar fracture is more common [2]
**Lateral malleolar:** lateral malleolar fractures as they result from forced inversion, which is easier as the lateral ankle ligaments are weaker
30
Lateral malleolar ligaments? [3]
Anterior talofibular Posterior talofibular Calcaneofibular
31
Which three muscles of the thigh form pes anserinus? Obturator internus, gracilis and sartorius Sartorius, rectus femoris, vastus medialis Sartorius, gracilis and semitendinosus Biceps brachii, brachialis, triceps brachii Gracilis, pectineus, adductor magnus
Which three muscles of the thigh form pes anserinus? **Obsartorius, gracilis and semitendinosus**
32
State the role of sartorius in moving hip and knee joints [2]
Sartorius can **flex** the **hip** AND **flex** the **knee** joint.
33
The unhappy triad is made from which 3 ligaments? [3]
Medial collateral ligament, lateral meniscus and anterior cruciate ligament
34
Which of the following muscles is the strongest flexor of the hip joint? Sartorious Iliopsoas External oblique Rectus femoris
Which of the following muscles is the strongest flexor of the hip joint? Sartorious **Iliopsoas** External oblique Rectus femoris
35
What is the insertion of the gluteus minimus muscle? Femoral neck Lesser trochanter Femoral head Greater trochanter
What is the insertion of the gluteus minimus muscle? Femoral neck Lesser trochanter Femoral head **Greater trochanter**
36
What nerve supplies the anterior compartment of the lower leg? Superficial fibular nerve Deep fibular nerve Posterior tibial nerve Femoral nerve
What nerve supplies the anterior compartment of the lower leg? Superficial fibular nerve **Deep fibular nerve** Posterior tibial nerve Femoral nerve
37
Apart from the anterior cruciate ligament, which other structure prevents overextension of the knee joint? Meniscus Posterior cruciate ligament Arcuate popliteal ligament Medial collateral ligament
Apart from the anterior cruciate ligament, which other structure prevents overextension of the knee joint? Meniscus Posterior cruciate ligament **Arcuate popliteal ligament** Medial collateral ligament
38
Which statement about the posterior cruciate ligament is true? It prevents overextension of the knee joint It restricts internal and external rotation of the extended knee It prevents anterior rolling and displacement of the femoral condyle It prevents posterior rolling and displacement of the femoral condyle It is a shock absorber
It prevents anterior rolling and displacement of the femoral condyle
39
Which of the following nerves is involved in tarsal tunnel syndrome? Deep peroneal nerve Femoral nerve Tibial nerve Common peroneal nerve Superficial peroneal nerve
Which of the following nerves is involved in tarsal tunnel syndrome? Deep peroneal nerve Femoral nerve **Tibial nerve** Common peroneal nerve Superficial peroneal nerve
40
Contents of the tarsal tunnel? [5]
TARSAL TUNNEL The tarsal tunnel is described as a region posterior to the medial malleolus and is bounded by the flexor retinaculum, turning it into a 'tunnel' through which important structures run. It is a useful landmark as it is where a clinician palpates the posterior tibial pulse and is the site of tarsal tunnel syndrome. Contents of the tarsal tunnel: **Tendon of tibialis posterior** **Tendon of flexor digitorum longus** **Posterior tibial artery** (and venae comitantes) **Tibial nerve** **Flexor hallucis longus** "Tom Dick And Very Nervous Harry" is a useful way to remember it!
41
"The hamstrings are made up of the semimembranosus, semitendinosus and the ______________ muscles." Vastus intermedius Biceps brachii Rectus femoris Psoas major Biceps femoris
"The hamstrings are made up of the semimembranosus, semitendinosus and the ______________ muscles." Vastus intermedius Biceps brachii Rectus femoris Psoas major **Biceps femoris**
42
Which of the following muscles inserts onto the most superior aspect of the greater trochanter of the femur? Obturator externus Gluteus medius Piriformis Gluteus minimus Obturator internus
Which of the following muscles inserts onto the most superior aspect of the greater trochanter of the femur? Obturator externus Gluteus medius **Piriformis** Gluteus minimus Obturator internus
43
What is the medial border of the femoral triangle? Medial border of adductor magnus Medial border of adductor longus Lateral border of adductor magnus Lateral border of adductor longus Medial border of sartorius
What is the medial border of the femoral triangle? Medial border of adductor magnus **Medial border of adductor longus** Lateral border of adductor magnus Lateral border of adductor longus Medial border of sartorius
44
Which of the following is not a recognised region of an adult long bone? Endophysis Epiphysis Diaphysis Metaphysis Synostosis
Which of the following is not a recognised region of an adult long bone? **Endophysis** Epiphysis Diaphysis Metaphysis Synostosis
45
Which of the following collection of bones constitute the ankle joint? Tibia fibula Tibia, fibula, and talus Tibia and talus only Tibia, fibula, talus and calcaneus
Which of the following collection of bones constitute the ankle joint? Tibia fibula **Tibia, fibula, and talus** Tibia and talus only Tibia, fibula, talus and calcaneus
46
Which muscles comprise the deep posterior compartment of the leg? Tibialis posterior, flexor hallucis longus, flexor digitorum longus, and plantaris Flexor hallucis brevis, flexor digitorum longus, tibialis posterior, and popliteus Gastrocnemius, soleus, and plantaris Tibialis posterior, flexor hallucis longus, flexor digitorum longus, and popliteus
Which muscles comprise the deep posterior compartment of the leg? Tibialis posterior, flexor hallucis longus, flexor digitorum longus, and plantaris Flexor hallucis brevis, flexor digitorum longus, tibialis posterior, and popliteus Gastrocnemius, soleus, and plantaris **Tibialis posterior, flexor hallucis longus, flexor digitorum longus, and popliteus**
47
The femoral artery is palpable at the mid-inguinal point, which is halfway between which two structures? Pubic symphysis and anterior superior iliac spine Pubic symphysis and anterior inferior iliac spine Pubic tubercle and lesser trochanter of the femur Pubic tubercle and anterior superior iliac spine Pubic tubercle and anterior inferior iliac spine
The femoral artery is palpable at the mid-inguinal point, which is halfway between which two structures? **Pubic symphysis and anterior superior iliac spine** Pubic symphysis and anterior inferior iliac spine Pubic tubercle and lesser trochanter of the femur Pubic tubercle and anterior superior iliac spine Pubic tubercle and anterior inferior iliac spine
48
What type of hip dislocation would occur because of a car accident like this? [1] How would a patient present prior to treatment?
49
What type of hip dislocation has occured? [1] In which leg? [1] Describe how you can tell [1]
**Right posterior hip dislocation:** Right limb **adducted**, flexed, **internally rotated**, and **shortened**.
50
What type of hip dislocation has occured? [1] In which leg? [1] Describe how you can tell [1]
anterior dislocation hip and leg in **extension**, **abduction**, and **external rotation**
51
Describe the presentation of this patient after the crash [3]
Posterior dislocation: limb **adducted**, flexed, **internally rotated**, and **shortened**.
52
How would the effected limb present in this injury? 3]
anterior dislocation hip and leg in **extension**, **abduction**, and **external rotation**
53
where does the aorta bifuricate into common iliac artery? [1]
L4
54
Which leg compartments and nerves are responsible for toe: Flexion [2] Extension [2]
Flexion: **posterior compartment**; **tibial** **nerve** Extension: **anterior compartment** & **deep peroneal nerve**
55
which three arteries branch off the internal iliac artery? [3] which out of ^^ are medial compartment of thigh? which out of ^^ are posterior compartment of thigh?
_from which artery does the superior gluteal artery arise from? [1]_ **internal iliac artery --\> superior gluteal artery internal iliac artery --\> inferior gluteal artery internal iliac artery --\> obturator artery** superior & inferior gluteal: **posterior region** obturator: **medial region**
56
superior and inferior gluteal artery relate to which muscle? [1]
superior and inferior gluteal artery relate to which muscle? [1] **piriformis !**
57
at what stage does femoral artery --\> popliteal artery? [1]
_at what stage does femoral artery --\> popliteal artery? [1]_ after going through the **adductor hiatus**
58
arcuate artery
59
lumbosacral plexus: which major nerves come from the lumbar plexus? [3] what are nerve roots?
_which major nerves come from the lumbar plexus? [3]_ **femoral nerve: L2, L3, L4 obturator nerve: L2, L3, L4 lateral cut. nerve of thigh: L2 & l3**
60
femoral nerve provides motor supply to which compartment of thigh? [1] what movement does this cause? [2] main muscles of anterior [3]
_femoral nerve provides motor supply to which compartment of thigh? [1]_ anterior _what movement does this cause? [2]_ flex hip extend knee _main muscles for ^?_ quadriceps sartoruis iliopsoas
61
**obturaror** nerve provides motor supply to which compartment of thigh? [1] what movement does this cause? [1] main muscles of this? [1]
* *obturaror** nerve provides motor supply to which compartment of thigh? [1] * *medial compartment** what movement does this cause? [1] **adduction of thigh** main muscles of this? [1] **adductors**
62
lateral cutaenous nerve occurs from which Vert levels? [2] what is role? [1]
lateral cutaenous nerve occurs from which Vert levels? [2] **L2 & L3** what is role? [1] sensory innervation to lateral aspect of thigh
63
which three nerves arise from sacral plexus? [3]
_which three nerves arise from sacral plexus? [3]_ •Sciatic nerve (Tibial and common peroneal nerves) •Superior gluteal nerve •Inferior gluteal nerve
64
sciatic nerve provides motor supply to which compartment of thigh? [1] what movement does this cause? [2] main muscles of this compartment [3]
_sciatic nerve provides motor supply to which compartment of thigh? [1]_ **posterior compartment** _what movement does this cause? [2]_ **extend hip flex knee** _main muscles of this compartment [3]_ •Semitendinosus •Semimembranosus Biceps femoris (long head
65
what are the 3 muscles compartments of the leg (knee - foot) what are the muscle movements each compartment do?
66
posterior dep compartment: innervation? movement? [2] blood supply?
posterior dep compartment: innervation: **tibial nerve** movement: **plantar flexion, flexion of digits** blood supply: **posterior tibial artery**
67
68
anterior leg compartment: innervation? movement? [2] blood supply?
anterior leg compartment: innervation: **deep peroneal nerve** movement: **dorsiflexion, extension of digits** blood supply: **anterior tibial artery**
69
lateral leg compartment: innervation? movement? blood supply?
lateral leg compartment: innervation: **superficial peroneal nerve** movement: **eversion** blood supply: **fibular artery**
70
which nerves provide sensory innervation to the image? [2]
71
damage to sciatic nerve is characterised by? [3]
oFoot drop oWasting of hamstrings, calf muscles and dorsiflexors oLoss of Achilles reflex
72
a postive trendelenburg test is likely to occur from damage to which nerve? superior gluteal nerve inferior gluteal nerve femoral nerve common peroneal nerve superficial peroneal nerve
a postive trendelenburg test is likely to occur from damage to which nerve? **superior gluteal nerve** inferior gluteal nerve femoral nerve common peroneal nerve superficial peroneal nerve
73
Describe the role of the the acetabulur labrum [1]
**Acetabulur labrum** is a fibrocartilaginous ring that helps with suction of the femur into the acetabulum. Doesn’t really add to the surface area, 10%, but acts with the synovial fluid to suction the head of the femur into the acetabulum
74
A: **ASIS (**anterior superior iliac spine) B: **pubic tubercle** C: **PSIS** D: i**schial spine** E: **ischial tuborisity F: inferior pubic ramus**
75
\* the hip joint is most stable is which position ? \*
\* the hip joint is most stable is which position ? \* **extension !**
76
which is the major extensor muscle of the hip? [1] which are the major abductor muscles of the hip? [2] which are the lateral rotators muscles of the hip? [2]
which is the major extensor muscle of the hip? [1] **gluteus maximus** which is the major abductor muscles of the hip? [2] **gluteus medius and minimus** which are the lateral rotators muscles of the hip? [2] **piriformis and lateral rotators**
77
during locomotion, which muscles stabilise the hip? [2] how? [1]
_during locomotion, which muscles stabilise the hip? [2]_ **gluteus medius and minimus:** contract to keep **pelvis aligned during locomotion** (otherwise, get contralateral (hip drop)
78
what is iliotibial tract? [1] what movement does tensor fascia lata cause? [1]
_what is iliotibial tract? [1]_ **long band of fascia that runs down lateral aspect of the knee. its a thickened portion of the fascia lata** (fascia that covers the thigh) _what movement does tensor fascia lata cause? [1]_ **abductor of hip**
79
the lateral rotators of the hip are innervated by which nerve supply? [3] which is the most important lateral rotator? [1]
_the lateral rotators of the hip are innervated by which nerve supply? [3]_ **L5, S1 & S2** _which is the most important lateral rotator? [1]_ **piriformis (**important for neurovasc landmark)
80
``` A = gluteus medius B = gluteus maximus C = piriformis D = other lateral rotators ```
81
medial compartment of the thigh - cause what movement on the hip? - made by which muscles? - innervated by?
medial compartment of the thigh - cause what movement on the hip? * *adduction** - made by which muscles? * *adductor longus, brevis and magnus, gracilis, pectineus and obturator externus ​** - innervated by? * *obturator nerve**
82
posterior compartment of the thigh - cause what movement on the hip? - made by which muscles? - innervated by?
posterior compartment of the thigh - cause what movement on the hip? **extension** - made by which muscles? **gluteus maximus hamstrings** - innervated by? **hamstring - sciatic nerve**
83
A: **flexor muscle (anterior comparment)** B: **abductor** C: **adductor**
84
what is blood supply to the head of femur like? which is main blood supply from?
which is main blood supply from: **retinacular artery**
85
A: Rectus femoris muscle B: Gracilis muscle C: Adductor magnus D: femoral artery / vein
86
which is this muscle? innervation? movement [2]
which is this muscle: **sartorius** innervation: **femoral nerve** movement [2]: **flexes hip AND knee**
87
which muscles do you find in the anterior compartment of leg? [3]
**sartoruis iliopsoas quadriceps**
88
medial compartment of thigh: - innervated by? - which muscles (dont worry too much) - movement? - generally, where do they attach proximally and distally?
medial compartment of thigh: - innervated by: **obturator nerve** - which muscles (dont worry too much): i) **adductor magnus** ii) **adductor longus** iii) **adductor brevis** iv) **gracilis** - movement: **adduction of leg** - generally, where do they attach proximally and distally: **proximally: pelvis, distally: linea asperea**
89
whats this muscle called?
semitendinosus: really long tendon !!
90
which is muscle A?
**semitendinosus** muscle (bc superior portion is almost aporneurotic)
91
which muscle is A&B? what are origins of A&B?
**Bicep femoris** **A -** long head - comes from _common hamstring - ischial tuboristy_ B - short head - _comes from posterior aspect of femur, laterally_
92
where do the Biceps femoris, Semimembranosus & Semitendinosus attach ? (medially or laterally)?
Biceps femoris: **laterally** Semimembranosus: **medially** Semitendinosus: **medially**
93
what are the 3 different muscles that insert at the medial aspect of the knee? [3] which compartment are they all originally from? [3] what is name for this meetin of three muscles? [3]
* Sartorius - **anterior** * Gracilis - **medial** * Semitendinosus - **posterior** **= pes anserinus !!**
94
what is the Q line? where is at a line between? [2] what s the angle in men? (compared to vertical) [1] whats the angle in women? (compared to vertical) [1]
Q line: **asis --\> centre of patella** what s the angle in men: **14 degress** whats the angle in women: **17 degrees**
95
whats it called when have a small q angle? whats it called when you have a large q angle? which condyle does this cause increased presssure on for small q [1] / large q [1]?
whats it called when have a small q angle: **genu varum - medial condyle** whats it called when you have a large q angle: **genu valgum - lateral condyle**
96
reflex test of patella: tests which nerve? [1] & which spinal segments[1]
reflex test of patella: tests **femoral nerve and spinal segments L2-L4 causes contraction of quads**
97
98
what is the role of the cruciate ligaments?
connecting the tibia and the femur to **prevent displacement of the tibia relative to the femur**
99
PCL prevents which movement of the tibia on the femur [1] ACL prevents which movement of the tibia on the femur [1] which is stronger - ACL or PCL?
PCL prevents **posterior** movement of the tibia **P4P** ​ACL prevents **anterior** movement of the tibia - stops hyperextension **PCL is stronger**
100
what is the medial menisci attached to [2] (anteriorly / posteriorly) what is the lateral menisici attached to? [1]
what is the medial menisci attached to [2] * *anteriorly:** **ACL** * *posteriorly:** **tibial collateral ligament** what is the lateral menisici attached to? [1] * *pcl** * *NOT ATTACHED TO LATERAL COLLATERAL LIGAMENT**
101
which ligaments make up the unhappy triad? [3]
Tearing of; * Medial meniscus * ACL * Tibial collateral ligament
102
103
which ligament structure stabilises the medial side of ankle? [1] what does ^ attach to? [3] what movement does it prevent? [1]
which ligament structure stabilises the medial side of ankle? [1] **medial / deltoid ligament** what does ^ attach to? [3] **medial malleoulus of tibia calcaneus navicular** what movement does it prevent? [1] **prevents subluxion**
104
which 3 ligaments make the the lateral ligament? [3] which are they clinically significant? [1]
_which 3 ligaments make the the lateral ligament? [3]_ **anterior talofibular posterior talofibular calcaneofibular** _which are they clinically significant? [1]_ because theyre seperate structures - **really likely to tear: lateral collateral ligament tear**
105
_dorsiflexion and toe extension:_ - innervated by which nerve? - which muscles? [3] - which compartment of leg? [1] _eversion:_ - innervated by which nerve? - which muscles? [2] - which compartment of leg? [1]
_dorsiflexion and toe extension:_ - innervated by which nerve: **deep branch of common peroneal nerve** - which muscles: **tibialis anterior, E. digitorum longus and E. hallicus longus - anterior compartment** _eversion_ - innervated by which nerve: **superficial branch of common peroneal** - which muscles: **fibularis longus and fibularis brevis** - **lateral compartment**
106
plantarflexion: which muscles do this ? - of superficial plexor and deep muscles
**_plantarflexion:_ superficial plexors:** - gastrocnemius - soleus - plantaris * *deep muscles: toe flexion** - flexor digitorum longus - flexor hallucis longus - tibialis posterior - **also does foot inversion**
107
what is arrow pointing to?
extensor reticulum
108
109
which muscles cause inversion of foot? [2] which muscles cause eversion of foot? [2]
which muscles cause inversion of foot? [2] **tibialis anterior tibialis posterior** which muscles cause eversion of foot? [2] **peroneus longus peroneus brevis**
110
which ligaments of foot get stretched out when foot planted, sot that when you take a step, release energy and help lift off? a) medial side [1] b) lateral side [2]
which ligaments of foot get stretched out when foot planted, sot that when you take a step, release energy and help lift off? a) medial side: **spring ligament** b) lateral side: **long and short plantar ligaments**
111
explain the arches of the foot? [3]
**medial longitudinal arch:** - open footprin side: middle of foot isnt it - contact with ground: _big toe & calcaneous_ - resilient due to large no. of bones **lateral longitudinal arch:** - flatter - less bones - talus transmits body weight through it - weight not central though - either goes forward or backwards **transverse arch:** not a true arch - maintained by some mscles and ligaments as longuitnial arches - bony fit is particularly good
112
where is weight distribution in foot?
found in medial & longitudinal arch - **not the transverse arch !!**
113
How do you treat a intertrochantric fracture? [1]
**Dynamic hip screw:** blate with barrel inserted to outside of femoral shaft. Screw goes through to femoral head gives controlled compression
114
How do you treat subtroch. hip fracture? [1]
IM nail
115
How does NOF present? [3]
Short, abducted and externally rotated
116
Which views are used for NOF fracture x-ray? [2]
**AP** - otherwise can't see shentons line & **lateral**
117
What does A point to? [1] What is the innervation? [1]
Tensor fascia lata Superior gluteal nerve
118
Which nerves supply sensory to colours shown?
119
PCL helps to stabilise knne joint particularly in which movement? [1] What is other role? [1]
Helps stabilise knee especially in **flexion** **Stops tibia moving backward** on femur **Stronger the ACL**
120
Describe the role of ACL [3]
**Stabilise knee in extension** and **prevents** **hyperextension** and **excessive internal rotation** Stops tibia moving forward on femur
121
Label the contents of the popliteal fossa
122
Compression of the tarsal tunnel can cause impingement to which nerve? [1]
Tibial nerve
123
Which artery is found within the ligamentum teres? [1]
Foveal artery