USMLE Road Map - Lower Limb I Flashcards Preview

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Flashcards in USMLE Road Map - Lower Limb I Deck (124):
1

The articular capsule of the hip joint is strengthened by 3 ligaments that extend from bones of the pelvic girdle to the neck of the femur:

1. The iliofemoral ligament.
2. The pubofemoral ligament.
3. The ischiofemoral ligament.

2

The iliofemoral ligament is the ...?

STRONGEST ligament at the hip joint, reinforces the anterior part of the capsule, and resists extension.

3

The pubofemoral ligament reinforces the ...?

Anterior and inferior parts of the capsule and resists abduction.

4

The ischiofemoral ligament reinforces ...?

The posterior part of the capsule and resists extension by screwing the head of the femur into the acetabulum.

5

The neck of the femur is a common site of a fracture. In such a fracture, the head of the femur ...?

May undergo AVASCULAR necrosis as a result of disruption of branches of the medial circumflex femoral artery --> The main source of arterial blood supply to the head and neck of the femur.

6

In patients with fractures of the femoral neck, the thigh is ...?

Laterally rotated by the short lateral rotators of the thigh at the hip and by the gluteus maximus.

7

A dislocation of the head of the femur at the hip joint occurs MC in the ...?

Posterior direction.

8

Dislocation of the head of the femur - The thigh is ...?

Shortened and medially rotated by the gluteus medius and minimus muscles.

9

Dislocation of the head of the femur - The sciatic nerve may ...?

Be compressed --> Weakness of muscles in the posterior thigh, leg, and foot and paresthesia over the posterior and lateral parts of the leg and the dorsal and plantar surfaces of the foot.

10

The knee joint is a ... joint.

MODIFIED HINGE JOINT --> Permits flexion/extension/rotation/gliding.

11

Flexion of the femur - Muscles involved?

1. Iliacus and psoas major.
2. Rectus femoris.
3. Sartorius.
4. Tensor fasciae latae.
5. Pectineus.

12

Iliacus and psoas major - Innervation:

Lumbar ventral rami - L2, L3.

13

Rectus femoris - Innervation:

Femoral - L2-L4.

14

Sartorius - Innervation:

Femoral L2-L3.

15

Tensor fasciae latae - Innervation:

Superior gluteal (L4-S1).

16

Pectineus - Innervation:

Femoral (L2-L3).

17

Extension of femur - Muscles:

1. Gluteus maximus.
2. Semimembranosus.
3. Semitendinosus.
4. Biceps femoris, long head.
5. Adductor magnus, ischial part.

18

Gluteus maximus - Innervation:

Inferior gluteal (L5-S2).

19

Semimembranosus - Innervation:

Sciatic (tibial) - L5-S1.

20

Semitendinosus - Innervation:

Sciatic (tibial) - L5-S2.

21

Biceps femoris, long head - Innervation:

Sciatic (tibial) - S1-S2.

22

Adductor magnus, ischial part - Innervation:

Obturator - L3-L4.

23

Adduction of femur - Muscles:

1. Adductor longus, brevis, magnus.
2. Gracilis.

24

Adductor longus, brevis, magnus - Innervation:

Obturator - L2-L4.

25

Adduction of femur - Gracilis - Innervation:

Obturator - L2-L4.

26

Abduction of femur - Muscles:

1. Gluteus medius and minimus.
2. Tensor fasciae latae.

27

Gluteus medius and minimus - Innervation:

Superior gluteal - L4-S1.

28

Medial rotation of femur - Muscles:

1. Gluteus minimus.
2. Gluteus medius, anterior fibers.

29

Lateral rotation of femur - Muscles:

1. Gluteus maximus.
2. Sartorius.
3. Obturator internus and superior gemellus.
4. Obturator externus.
5. Quadratus femoris and inferior gemellus.
6. Piriformis.

30

Obturator internus and superior gemellus - Innervation:

Nerve to obturator internus - L5-S2.

31

Obturator externus - Innevation:

Obturator - L3-L4.

32

Quadratus femoris and inferior gemellus - Innervation:

Nerve to quadratus femoris - L4-S1.

33

Piriformis - Innervation:

Nerve to piriformis - L5-S2.

34

Flexion of tibia and fibula - Muscles:

1. Semimembranosus.
2. Semitendinosus.
3. Biceps femoris: Long head, short head.
4. Gracilis.
5. Sartorius.
6. Popliteus.
7. Gastrocnemius.

35

Semimembranosus/Semitendinosus - Innervation:

Sciatic (tibial) L5-S2.

36

Gracilis - Innervation:

Obturator L2-L4.

37

Popliteus - Innervation:

Tibial - L4-S1.

38

Gastrocnemius - Innervation:

Tibial - S1-S2.

39

Extension of tibia and fibula - Muscles involved:

Quadriceps femoris:
1. Vastus medialis.
2. Vastus lateralis.
3. Vastus intermedius.
4. Rectus femoris.

40

Quadriceps femoris - Innervation:

Femoral nerve - L2-L4.

41

Lateral rotation of tibia and fibula - Muscles:

1. Gluteus maximus.
2. Biceps femoris.
3. Tensor fasciae latae.

42

The 3 MC injured structures at the knee are:

1. The tibial collateral ligament.
2. The medial meniscus.
3. The ACL.
--> The terrible triad.

43

Patients with a medial meniscus tear have pain when the leg is ...?

Medially rotated at the knee.

44

The ankle joints include:

1. The talocrural.
2. The subtalar.
3. The transverse tarsal.

45

The talocrural joint is formed by ...?

An articulation between the trochlea of the talus and the lateral and medial malleoli of the fibula and tibia, respectively.

46

The foot is more stable in a ... position.

Dorsiflexed position, than in plantar-flexed position, because the anterior part of the superior surface of the trochlea of the talus is WIDER than the posterior part at the talocrural joint.

47

The tendons of the ... enter the sole of the foot after passing posterior and inferior to the MEDIAL malleolus.

1. Tibialis posterior.
2. Flexor digitorum longus.
3. Flexor hallucis longus.

48

The tendons of the ... and ... enter the sole of the foot after passing posterior and inferior to the lateral malleolus.

Fibularis (peroneus) longus and fibularis (perineus) brevis muscles.

49

Which 2 ligaments strengthen the talocrural joint:

1. Deltoid (medial).
2. Lateral ligaments.

50

The deltoid ligament is the ...?

Stronger of the 2 collateral ligaments and has 4 components, which extend from the tibia to the talus, navicular, and calcaneus.

51

The lateral ligament ...?

Has 3 components, which extend from the fibula to the talus and calcaneus.

52

Plantar flexion of foot - Muscles:

1. Gastrocnemius.
2. Soleus.
3. Plantaris.
4. Tibialis posterior.
5. Flexor digitorum longus.
6. Flexor hallucis longus.
ALL INNERVATED BY THE TIBIAL NERVE (L5-S2).

53

Dorsiflexion of foot - Muscles involved:

1. Tibialis anterior.
2. Extensor hallucis longus.
3. Extensor digitorum longus.
ALL INNERVATED BY THE DEEP PERONEAL --> L4-S1.

54

Ankle sprains - Inversion or eversion ankle sprain is more common at the talocrural joint.

Inversion --> The anterior talofibular part of the lateral ligament is commonly torn in inversion ankle sprains.

55

The subtalar joint:

The ball-and-socket subtalar joint is formed by the articulation between the talus and the calcaneus.

56

The subtalar joint permits:

Supination/Pronation.

57

Subtalar joint - Supination:

A combination of:
1. Plantar flexion.
2. Inversion.
3. Adduction.

58

Subtalar joint - Pronation:

Combination of:
1. Dorsiflexion.
2. Eversion.
3. Abduction.

59

The transverse tarsal joints are formed by ...?

The articulations of the talus with the navicular and the calcaneus with the cuboid.

60

The transverse tarsal joints contribute to ...?

Inversion and eversion with the subtalar joint.

61

The joints of the toes and the actions of muscles of the foot are similar to those of the ...?

Hand.

62

The sole of the foot contains:

1. Short abductors and flexors of the great toe + little toe, respectively.
2. Lacks eminences and opponens muscles.

63

The quadratus plantae is a plantar muscle with ...?

NO counterpart in the hand; it acts to straighten out the oblique pull of the flexor digitorum longus tendons.

64

Arterial blood supply to the lower limb:

1. Femoral.
2. Popliteal.
3. Anterior and posterior tibial arteries.
--> Provide MOST of the arterial blood supply to the lower limb.

65

The femoral artery begins at the ...?

Inguinal ligament as a continuation of the external iliac artery.

66

The femoral artery courses ...?

Lateral to the femoral vein and medial to the femoral nerve through the femoral triangle in the anterior thigh.

67

The femoral artery enters the ... and becomes the popliteal artery after passing through the ... .

Adductor canal, adductor hiatus.

68

The profunda femoral artery gives rise to the ...?

Lateral and medial circumflex arteries --> Supply the thigh, the head and neck of the femur, and the hip joint.

69

Which artery is the main source of arterial blood supply to the head and neck of the femur?

The medial circumflex femoral artery.

70

The profunda femoral artery gives rise to ...?

4 perforating arteries --> Supply the medial thigh and pass through the adductor magnus to supply the muscles in the posterior thigh.

71

The pelvic girdle consists of ...?

The ilium, ischium, and pubis, which are fused together at the ACETABULUM.
These joints of the pelvic girdle include the sacroiliac joints and the hip joints.

72

Which arteries contribute to the cruciate anastomosis in the posterior thigh?

1. The medial/lateral circumflex femoral arteries.
2. The inferior gluteal artery.
3. The 1st perforating artery.

73

The cruciate anastomosis may contribute to ...?

Collateral circulation of the lower limb if the femoral artery becomes occluded.

74

The popliteal artery begins ...?

At the adductor hiatus as a continuation of the femoral artery.

75

The popliteal artery courses through the ...?

Popliteal fossa posterior to the knee with the tibial nerve.

76

The popliteal artery gives rise to ...?

5 genicular arteries, which supply the knee joint.

77

Which arteries contribute to the collateral circulation of the knee?

1. The 5 genicular branches of the popliteal artery.
2. The descending genicular branch of the femoral artery.
3. The descending branch of the lateral circumflex femoral artery.
4. The anterior branch of the anterior tibial artery.

78

The popliteal artery ends at ...?

The inferior border of the popliteus by dividing into anterior and posterior tibial arteries.

79

Inversion of foot - Muscles:

1. Tibialis anterior.
2. Extensor hallucis longus.
3. Tibialis posterior.

80

Innervation of tibialis anterior and extensor hallucis longus:

Deep peroneal - L4-S1.

81

Innervation of tibialis posterior:

Tibial - L5-S1.

82

Eversion of foot - Muscles:

1. Peroneus longus.
2. Peroneus brevis.
3. Peroneus tertius.

83

Innervation of peroneus longus/brevis:

Superficial peroneal - L5-S1.

84

Innervation of peroneus tertius:

Deep peroneal - L4-S1.

85

Flexion of the great toe (DIP) - Muscle:

Flexor hallucis longus.

86

Innervation of flexor hallucis longus:

Tibial + Medial plantar - L5-S1.

87

Flexion of toes 2-5 (DIP) - Muscle:

Flexor digitorum longus.

88

Innervation of flexor digitorum longus:

Tibial - L5-S1.

89

Straightens tendon of flexor digitorum longus - Muscle:

Quadratus plantae (Fl. accessorius).

90

Innervation of quadratus plantae:

Lateral plantar - S1-S2.

91

Flexion of toes 2-5 (PIP) - Muscle:

Flexor digitorum brevis.

92

Flexion digitorum brevis - Medial plantar:

L5-S1.

93

Flexion of toe 5 - Muscle:

Flexor digiti minimi brevis.

94

Flexor digiti minimi brevis - Innervation:

Lateral plantar - S1-S2.

95

Flexion of toes 2-5 (MP) - Muscles:

1. Lumbrical I.
2. Lumbricals II, III, IV.
3. Interossei.

96

Innervation of lumbricals I, II, III, IV:

I --> Medial plantar, toe 2 --> L5-S1.
II, III, IV --> Lateral plantar, toes 3-5 --> S1-S2.

97

Innervation of interossei:

Lateral plantar - S1-S2.

98

Extension of great toe - Muscles:

1. Extensor hallucis longus.
2. Extensor hallucis brevis.

99

Innervation of extensor hallucis longus/brevis:

Deep peroneal - L5-S1.

100

Extension of toes 2-4 - Muscles:

Extensor digitorum longus/brevis.

101

Innervation of extensor digitorum longus/brevis:

Deep peroneal - L4-S1.

102

Extension of toes 2-5 (IP joints) - Muscles:

Lumbricals.

103

Abduction at MP of toe 1 - Muscle:

Abductor hallucis - Medial plantar L5-S1.

104

Abduction at MP of toes 2-4 - Muscle:

Dorsal interossei - Lateral plantar - S1-S2.

105

Abduction at MP of toe 5 - Muscle:

Abductor digiti minimi - Lateral plantar - S1-S2.

106

Adduction at TMP of toe 1 - Muscle:

Adductor hallucis - Lateral plantar - S1-S2.

107

Adductor at TMP - Toes 3-5 - Muscle:

Plantar interossei - Lateral plantar - S1-S2.

108

The anterior tibial artery enters the ...?

Anterior compartment of the leg proximal to the interosseous membrane between the tibia and the fibula.

109

The anterior tibial artery courses with the ...?

Deep fibular (peroneal) nerve and supplies the anterior compartment of the leg.

110

The anterior tibial artery continues as the ...?

Dorsalis pedis, on the dorsal aspect of the foot.

111

The dorsalis pedis branches into ...?

An arcuate artery, which gives rise to digital branches that supply the toes, and a deep plantar artery, which contributes to a plantar arterial arch in the sole of the foot.

112

The posterior tibial artery arises from the ...?

Popliteal artery.

113

The posterior tibial artery courses ...?

Through the posterior compartment of the leg with the tibial nerve.

114

The posterior tibial artery supplies the ...?

Posterior compartment of the leg.

115

The posterior tibial artery gives rise to the ...?

Fibular artery.

116

The fibular artery supplies:

The posterior compartment of the leg and sends perforating branches into the lateral compartment of the leg --> Supply the fibularis longus and brevis muscles.

117

The posterior tibial artery passes into the ...?

Foot behind the medial malleolus adjacent to the tendons of the tibialis posterior and flexor digitorum longus muscles and divides into the medial + lateral plantar arteries --> Supply the sole of the foot.

118

Branches of the internal iliac artery supply the ...?

Gluteal region and medial thigh and include the:
1. Superior gluteal.
2. Inferior gluteal.
3. Obturator arteries.

119

The superior gluteal artery enters the ...?

Gluteal region with the superior gluteal nerve superior to the piriformis after passing through the greater sciatic foramen.

120

The superior gluteal artery supplies:

1. The gluteus maximus.
2. Medius.
3. Minimus muscles.

121

The inferior gluteal artery enters the ...?

Gluteal region with the inferior gluteal nerve inferior to the piriformis muscle after passing through the greater sciatic foramen.

122

The inferior gluteal artery supplies the ...?

1. Gluteus maximus.
2. Short lateral rotators of the hip.
3. Proximal parts of the hamstrings.

123

The obturator artery enters the ...?

Medial thigh with the obturator nerve after passing through the obturator foramen.

124

The obturator artery supplies the:

1. Adductor muscles.
2. Obturator externus.
3. Pectineus.
4. Gracilis.