USMLE Road Map - Lower Limb II Flashcards Preview

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Flashcards in USMLE Road Map - Lower Limb II Deck (114):
1

Which 2 important veins are superficial veins?

The great and small saphenous veins.

2

The great saphenous vein arises from the ...?

Medial aspect of the dorsal venous arch of the foot.

3

The great saphenous vein courses ...?

Anterior to the medial malleolus, through the medial aspect of the leg with the saphenous nerve, and through the medial thigh.

4

The great saphenous vein drains into the ...?

Femoral vein after passing through the saphenous hiatus - a fault in the fascia lata.

5

The small saphenous vein arises from the ...?

Lateral aspect of the dorsal venous arch of the foot.

6

The small saphenous vein arises ...?

From the lateral aspect of the dorsal venous arch of the foot.

7

The small saphenous vein courses ...?

Posterior to the lateral malleolus and then through the posterior leg with the sural nerve.

8

The small saphenous vein passes ...?

Between the 2 heads of the gastrocnemius muscle and drains into the popliteal vein.

9

The lumbar plexus is formed by the ...?

Ventral rami of L1 through L4 with a small contribution from T12 and is found on the posterior abdominal wall and greater pelvis.

10

The ventral rami of the lumbar plexus branch into ...?

Posterior and anterior divisions.

11

The posterior and anterior divisions form 2 main nerves:

1. The femoral.
2. The obturator.
respectively.

12

The lumbosacral plexus is formed by the ...?

Ventral rami of L4-S3 and is found in the lesser pelvis.

13

The ventral rami of the lumbosacral plexus branch into ...?

Posterior and anterior divisions.

14

The posterior and anterior divisions form 2 terminal nerves:

The common fibular (peroneal) and tibial nerves, respectively.
The superior and inferior gluteal nerves also contain posterior division fibers.

15

The lower limb is drained by a ... and a ... system of veins.

Superficial, deep.

16

During development, the lower limb undergoes a MEDIAL rotation so that the ...?

Flexor muscles that were anterior in the embryo come to be situated POSTEROMEDIALLY.
The extensor muscles that were posterior in the embryo come to be situated ANTEROLATERALLY.

17

In the plexus, fibers of L4 unite with fibers of L5 to form the ...?

Lumbosacral trunk.

18

The lumbosacral trunk emerges from the ...?

Medial aspect of the psoas major muscle, cross the pelvic brim, and joins with the ventral rami of the first, second, and third sacral nerves to form the lumbosacral plexus.

19

The terminal and collateral nerves of the lumbosacral plexus exit the pelvis through the ...?

Greater sciatic foramen.

20

The femoral nerve contains ...?

POSTERIOR division fibers from the L2-L3-L4 ventral rami.

21

The femoral nerve emerges from ...?

The lateral border of the psoas major in the iliac fossa and passes into the anterior thigh posterior to the inguinal ligament and lateral to the femoral artery.

22

The femoral nerve innervates muscles in the ...?

Anterior compartment of the thigh:
1. 4 heads of the quadriceps femoris.
2. Iliopsoas.
3. Sartorius.
4. Pectineus.
--> Act to flex the thigh at the hip and extend the leg at the knee.

23

The femoral nerve innervates the skin of the ...?

Anterior + medial thigh (medial and intermediate cutaneous nerves).

24

The femoral nerve gives rise to the ...?

Saphenous nerve (L3, L4).

25

The saphenous nerve is the ...?

Longest branch of the femoral nerve and is the only branch of the lumbar plexus to cross the knee joint.

26

The saphenous nerve enters the ...?

Adductor canal but leaves the canal without passing through the adductor hiatus.

27

The femoral nerve may be damaged in the abdomen by ...?

An abscess of the psoas major.

28

Damage of the femoral nerve - Patients experience ...?

Weakness in the ability to flex the thigh at the hip, a weakness in the ability to extend the leg at the knee, and a diminished patellar tendon reflex.

29

The saphenous nerve may be lesioned during a ...?

Surgical procedure of the leg to remove part of the great saphenous vein, or it may be lacerated as it pierces the wall of the adductor canal.

30

Damage of the saphenous nerve - Patients experience ...?

Pain and paresthesia in the skin of the medial aspect of the leg and foot.

31

The obturator nerve contains ...?

Anterior division fibers from the L2-L3-L4 ventral rami.

32

Common fibular nerve may be compressed in ...?

Piriformis syndrome.

33

Posterior cutaneous nerve of the thigh?

Often simultaneously damaged with sciatic nerve.

34

The sciatic nerve may be compressed by ...?

Posterior dislocation of the femur.

35

The lateral cutaneous nerve of the thigh may be compressed ...?

Posterior to inguinal lig.

36

The femoral nerve may be compressed by a ...?

Psoas abscess or neoplasm.

37

The obturator nerve may be compressed in ...?

Pelvis.

38

The common fibular nerve is subject to ...?

Trauma at the neck of fibula.

39

The saphenous nerve is subject to damage during ...?

Varicose vein surgery.

40

The deep fibular nerve may be compressed in ...?

Anterior compartment of leg.

41

The tibial nerve may be compressed in ...?

Tarsal tunnel syndrome.

42

The obturator nerve emerges from the ...?

Medial side of the psoas major, crosses the pelvic brim, and courses anteriorly and inferiorly in the lesser pelvis to the obturator foramen.

43

The obturator nerve passes through the ...?

Obturator foramen and through the obturator externus into the medial thigh.

44

The obturator nerve divides into an ...?

ANTERIOR branch, which passes between the adductor longus and brevis muscles, and a POSTERIOR branch, which passes between the adductor brevis and adductor magnus.

45

The obturator nerve innervates muscles in the ...?

Medial thigh:
1. Adductor longus, brevis, and magnus.
2. Gracilis.
3. Obturator externus muscles.

46

The obturator nerve innervates skin in ...?

A small region of the medial thigh.

47

The obturator nerve is most commonly lesioned in ...?

The pelvis.

48

Patients with obturator nerve lesions are ...?

Unable to adduct the thigh at the hip and may have paresthesia in skin of the medial thigh.

49

L4 - Cause of lesion:

Osteoarthritis.

50

L4 - Location of dermatome:

Medial leg.

51

L4 lesion - Muscles affected:

1. Quadriceps.
2. Iliopsoas.
3. Hip adductors.

52

L4 lesion - Suppressed reflex:

Patellar tendon.

53

L5 - Cause of lesion:

Herniation of disk between L4-L5.

54

L5 - Location of dermatome:

1. Dorsum of foot.
2. Great toe.
3. Toes 2 and 3.

55

L5 - Muscles affected:

1. Foot dorsiflexors.
2. Toe extensors.

56

S1 - Cause of lesion:

Herniation of disk between L5 and S1.

57

S1 - Location of dermatome:

1. Posterior leg.
2. Lateral foot.
3. Toes 4, 5, and sole.

58

S1 - Muscles affected?

Plantar flexors.

59

S1 lesion - Suppressed reflex:

Achilles tendon.

60

Lesion of obturator nerve (L2-L3-L4) - Cause:

1. Pelvic neoplasm.
2. Pregnancy.

61

Lesion of obturator nerve - Altered cutaneous sensation:

Medial thigh.

62

Lesion of obturator nerve - Weakness in?

Adduction at hip.

63

Lesion of femoral nerve (L2-L3-L4) - Cause:

1. Diabetes.
2. Pelvic neoplasm.
3. Psoas abscess.

64

Lesion of femoral nerve (L2-L3-L4) - Altered cutaneous sensation:

1. Anterior thigh.
2. Medial leg to medial malleolus.

65

Lesion of femoral nerve (L2-L3-L4) - Weakness in:

1. Flexion of hip.
2. Extension of leg at knee.

66

Lesion of common fibular nerve (L4-S2) - Cause:

1. Compression at neck of fibula.
2. Hip fracture.
3. Dislocation of femur.
4. Piriformis syndrome.

67

Common fibular nerve (L4-LS2) - Location of dermatome:

1. Anterior and lateral leg.
2. Dorsum of foot.

68

Lesion of common fibular nerve (L4-S2) - Muscles affected:

1. Dorsiflexion.
2. Eversion of foot.

69

Lesion of common fibular nerve (L4-S2) - Suppressed reflex:

1. Foot drop.
2. Steppage gait.

70

Lesion of tibial nerve (L4-S3) - Cause:

1. Diabetes.
2. Hip fracture.
3. Dislocation of femur.

71

Tibial nerve - Location of dermatome:

1. Posterior leg, sole.
2. Lateral foot.

72

Lesion of tibial nerve (L4-S3) - Muscles affected:

1. Plantar flexion.
2. Flexion of toes.

73

Lesion of tibial nerve (L4-S3) - Suppressed reflex:

Can't stand on "tiptoes".

74

Lesion of superior gluteal nerve (L4-S1) - Cause:

1. Misplaced gluteal injection.
2. Pelvic neoplasm.

75

Lesion of superior gluteal nerve - Muscles affected:

Abduction at hip.

76

Lesion of superior gluteal nerve (L4-S1) - Suppressed reflex:

1. Pelvic tilt.
2. Waddling gait.

77

Lesion of inferior gluteal nerve (L5-S2) - Cause:

Pelvic neoplasm.

78

Lesion of inferior gluteal nerve (L5-S2) - Muscles affected:

Extension at hip from flexed position.

79

Lesion of inferior gluteal nerve (L5-S2) - Suppressed reflex:

Can't get up from chair.

80

The subcostal nerve (T12) passes between ...?

The psoas major + quadratus lumborum muscles inferior to the 12th rib.

81

The subcostal nerve innervates ...?

Abdominal musculature and overlying skin of the lateral and anterior abdominal wall.

82

The iliohypogastric nerve (T12-L1) emerges between the ...?

Psoas major + quadratus lumborum muscles INFERIOR to the subcostal nerve.

83

The iliohypogastric nerve (T12-L1) innervates ...?

Abdominal musculature and the skin of the inguinal and hypogastric regions of the lateral and anterior abdominal wall.

84

The ilioinguinal nerve courses ...?

Inferior to the iliohypogastric nerve.

85

The ilioinguinal nerve (L1) innervates ...?

The abdominal musculature and the skin of the inguinal and hypogastric regions of the lateral and anterior abdominal wall.

86

The ilioinguinal nerve also ...?

Pierces the inguinal canal and passes through the superficial inguinal ring to innervate the skin of:
1. The medial thigh.
2. Labium majus.
3. Anterior aspect of scrotum.

87

The genitofemoral nerve (L1-L2) courses ...?

Through and then anterior to the psoas major muscle.

88

The genitofemoral nerve (L1-L2) divides into:

A femoral and a genital branch:
1. The femoral branch passes posterior to the inguinal ligament and innervates the skin of the medial thigh.
2. The genital branch enters the inguinal canal through the deep inguinal ring and innervates the cremasteric muscle.

89

The lateral femoral cutaneous nerve (L2-L3) emerges lateral to the ...?

Psoas major muscle and then crosses the iliacus to reach the anterior superior iliac spine.

90

The lateral femoral cutaneous nerve (L2-L3) descends into ...?

The lateral thigh after passing posterior to the inguinal ligament.

91

The lateral femoral cutaneous nerve may be compressed as it passes ...?

Posterior to the lateral part of the inguinal ligament just medial to the anterosuperior iliac spine.

92

Patients with compression of the lateral femoral cutaneous nerve ...?

Present with pain and paresthesia in the anterolateral thigh - Meralgia paresthetica.

93

The superior gluteal nerve - Fibers from ...?

Posterior division fibers from L4-L5-S1.

94

The superior gluteal nerve enters the gluteal region with ...?

The superior gluteal artery by passing through the greater sciatic foramen SUPERIOR to the piriformis muscle.

95

The superior gluteal nerve innervates ...?

1. The gluteus medius.
2. The gluteus minimus.
3. The tensor fasciae latae muscles.

96

Patients with a lesion of the superior gluteal nerve have a ...?

Weakness in the ability to abduct the thigh at the hip.

97

Superior gluteal nerve lesions - Patients experience a ...?

Waddling or Trendelenburg gait, in which the pelvis sags on the side of the unsupported limb.
--> The pelvis sags on the side that is opposite the side of the lesioned superior gluteal nerve.

98

The inferior gluteal nerve - Fibers from ...?

Posterior division fibers from L5-S2.

99

The inferior gluteal nerve enters the ...?

Gluteal region by passing through the greater sciatic foramen INFERIOR to the piriformis muscle.

100

The inferior gluteal nerve innervates the ...?

Gluteus maximus.

101

Patients with a lesion of the inferior gluteal nerve have a ...?

Weakness in the ability to laterally rotate and extend the thigh at the hip.
--> Difficulty in climbing stairs or rising from a chair.

102

Patients with inferior gluteal nerve lesions may have a ...?

Gluteus maximus gait, in which they thrust their torso posteriorly in an attempt to counteract the weakness of the gluteus maximus.

103

The tibial nerve - Fibers from ...?

Anterior division fibers from L4-S3.

104

The tibial nerve enters the ...?

Gluteal region with the common fibular nerve in the sciatic nerve by passing through the greater sciatic foramen inferior to the piriformis muscle.

105

The tibial nerve courses through the ...?

1. Posterior thigh deep to the hamstrings before separating from the common fibular nerve at the superior border of the popliteal fossa.
2. Courses in the posterior part of the leg with the posterior tibial artery and then passes through the tarsal tunnel and into the sole of the foot after coursing behind medial malleolus.

106

The tibial nerve innervates muscles in the ...?

Posterior thigh, posterior leg, plantar foot.

107

The tibial nerve divides into the ...?

Medial and lateral plantar nerves distal to the tarsal tunnel.

108

The distribution of the medial plantar nerve (L5-S2) is similar to that of ...?

The median nerve in the hand.

109

The medial plantar nerve innervates 4 muscles in the sole of the foot:

1. Flexor digitorum brevis.
2. Flexor hallucis brevis.
3. Abductor hallucis.
4. 1st lumbrical.

110

Distribution of the lateral plantar nerve (L5-S2) is similar to that of the ...?

Ulnar nerve of the hand.

111

The lateral plantar nerve innervates the ...?

Rest of the intrinsic foot muscles.

112

The sciatic nerve is susceptible to damage from an ...?

IM injection in the lower medial quadrant of the gluteus maximus muscle, or it may be compressed as a result of a posterior dislocation of the femur.

113

In patients with tibial nerve lesions in the gluteal region, weakness may be evident in the ability to ...?

Flex the leg at the knee and plantar flex at the ankle.

114

The tibial nerve may be compressed at the ...?

Ankle as it courses through the tarsal tunnel adjacent to the medial malleolus.
--> Patients with tarsal tunnel syndrome have pain and paresthesia in the sole of the foot.