3 - Zill - Lower Extremity

Question 1

Innominate Bone

Answer 1

Pelvis

Attachment of lower extremity

Question 2

Hallux

Answer 2

Big Toe

Question 3

Fibula and Tibia

Answer 3

Fibula - Lateral, not part of knee

Tibia - Medial, shin, lower part of knee

Question 4

Thigh vs Leg

Answer 4

Thigh - upper leg around femur

Leg - lower leg around tibia and fibula

Question 5

Ankle

Answer 5

Functionally two joints

1 between tibia, fibula, and talus

1 between talus and other foot bones

Question 6

How do the arms and legs develop in utero?

Answer 6

Homology; they rotate in different directions during future development

Question 7

What is the orientation of hands and feet in utero?

Answer 7

Homologous orientation, face medially

Upper exremities rotate laterally

Lower extremities rotate medially

Question 8

Dermatomes of Toes

Answer 8

L4 Big Toe

L5 Middle Toes

S1 Little Toe

Question 9

Flexion and Extension of Hip and Knee

Answer 9

Hip - Flex Anterior, Extension Posterior

Knee - Flex Posterior, Extension Anterior

Question 10

Abduction v Adduction

Answer 10

Abduction - Move away from midline

Adduction - Move toward midline

Question 11

Movement of the Foot

Flexion/Extension

Inversion/Eversion

Answer 11

Dorsiflexion = Lift foot from ground

Plantar Flexion = Push on gas pedal

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Inversion = Sole faces medially (most common)

Eversion = Sole faces laterally (less common)

Question 12

Three Major Bones of Pelvis

Socket?

Midline between pubic bones

Answer 12

Ilium (“wing”)

Ischium (sit-bone)

Pubis (front of pelvis)

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Socket = Acetabulum

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Pubic Symphysis

Question 13

Anterior Superior Iliac Spine

• -

Pubic Tubercle

• -

Obturator Foramen

Answer 13

Palpable anterior projection for muscle attachment

• -

Palpable attachment for Inguinal Ligament

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Large opening made of ischium and pubis, covered by Obturator membrane for muscle attachment

Question 14

Ischial Tuberosity

Answer 14

Bony prominence on posterior part of ischium; “sit bones”

Question 15

What ligaments prevent the sacrum from rotating due to weight transmitted down vertebral column?

Answer 15

Sacrotuberous and Sacrospinous ligaments

Question 16

Where do muscles attach on the femur?

What area of the femur is subject to fractur?

Answer 16

Muscles attach to trochanters

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Neck - narrow region is subject to fracture

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Question 17

Patella

Answer 17

Sesamoid bone, located in tendon of quadriceps femoris muscle

Patella can appear bipartite or tripartite

Can misinterpret as facture on x-ray

Question 18

Palpable lower features of Tibia and Fibula

What do these form?

Palpable upper feature of the fibula?

Answer 18

Medial malleolus (tibia)

Lateral malleolus (fibula)

• -

Form joint for dorsiflexion, plantar flexion

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Head, important for Foot Drop (nerve damage)

Question 19

Answer 19

Question 20

What bones if the foot an arch?

Why is this important?

Answer 20

Talus sits above the Calcaneus

Arch gives spring-like

Question 21

Great Saphenous Vein

Answer 21

Superficial vein that courses on whole medial side of lower extremity

Starts at dorsal venous arch of foot

Ascends anterior to Medial Malleolus

Question 22

Small Saphenous Vein

Answer 22

Superficial vein that drains from lateral side of Dorsal Venous Arch, found on posterior side of Lateral Malleolus

Question 23

Perforating Veins

How does fluid travel in these?

Answer 23

Connect Superficial Veins to Deep Veins; have valves

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Superficial to Deep (ONE WAY)

Question 24

How is fluid pushed in veins of the lower extremities?

Answer 24

Valves prevent flow being pooled from gravity and muscles constricting push blood up

Question 25

Varicose Veins

Answer 25

Valves of perforating veins can become incompetent, leading to pooling of blood

Question 26

Lymphatic System: What do the vessels follow?

Horizontal Group

Vertical Group

Popliteal Nodes

Deep Inguinal Nodes

Answer 26

Vessels follow veins

Horizonal Group: Located below inguinal ligament

Vertical Group: Located along termination of Great Saphenous

Popliteal Nodes: Posterior to knee, drain vessels of Small Saphenous vein

Deep Inguinal Nodes: Located medial to femoral vein

Question 27

What level of innervation does patellar tendon reflex test?

Answer 27

L2-L4

Question 28

Muscles of abdomen

Answer 28

Rectus Abdominis (six pack)

External oblique muscle

Question 29

Inguinal Ligament

Answer 29

Thickened fascia of external oblique muscle

Allows passage of femoral vein, artery, and nerve

Question 30

Iliotibial Tract

Answer 30

Helps keep knee extended and provide lateral stability when standing

Attaches to ilium above and lateral condyle of ribia below

Extends leg after other muscles have extended knee

Question 31

Saphenous Opening

Answer 31

Allows for passage of Great Saphenous Vein

Inferior to inguinal ligament

sharp edged lateral side (Falciform margin)

Question 32

Lateral Femoral Cutaneous Nerve of Thigh - Clinical Issues

Answer 32

Can be compressed resulting in meralgia, from obesity/diabetes

Question 33

Nerve of Gluteal Region

Answer 33

Posterior Cutaneous Nerve of Thigh