Anatomy 2 (after S18)

Question 1

Where do the testicles form and end up

Answer 1

• form in the retroperitoneum

- migrates through the abdominal wall into the scrotum

Question 2

Where is a common site for hernias

Answer 2

-the inguinal canal

Question 3

What is the superficial inguinal ring

Answer 3

• basically the triangular space produced by how the external oblique aponeurosis are attached
• only external oblique aponeurosis in lower 3rd of abdomen
• some fibres attach to the pubic tubercle and some to the pubic tubercle on the other side

Question 4

Where does the inguinal ligament attach to and actually is it

Answer 4

• the pubic tubercle

- an opening in the transversalis fascia

Question 5

Which abdominal muscle forms the starts in front of the inguinal canal and travels behind it and what does it do to the inguinal canal when it contracts

Answer 5

• the internal oblique muscle
• it forms the front wall (superiorly), roof and back wall (inferiorly) of the inguinal canal
• it closes the inguinal canal and stops any bowel in the abdomen coming down the inguinal canal and causing a hernia

Question 6

Which artery is the deep inguinal ring just lateral to

Answer 6

-the inferior epigastric artery

Question 7

Where do the internal oblique muscle and transversus abdominis muscle attach and insert on in the lower 1/3 of the abdomen

Answer 7

Internal oblique muscle - arise from the lateral 2/3 of the inguinal ligament and attach on the conjoint tendon

Transversus abdominis - arise from lateral 1/3 of the inguinal ligament and attach to the pubic tubercle

Question 8

What is the cremesteric muscle

Answer 8

• as the spermatic cord descends through the inguinal canal
• it is surrounded first by deep spermatic fascia derived from the transversalis fascia layer
• the next muscle layer that surrounds the spermatic cord derived from the internal oblique muscle is the cremesteric muscle
• the next muscle layer that surrounds the spermatic cord derived form the external oblique layer is the external spermatic fascia

-the ilioinguinal nerve runs on its surface

Question 9

Why is the pampiniform plexus of veins important?

Answer 9

-spermatogenesis needs a body temperature lower than our core temparature so men have multiple veins surrounding the testis are cooled by the high surface area of the scrotum which cools the testis to the right temperature for spermatogenesis

Question 10

What does the vas deferens do and how is different from other vessels in the spermatic cord

Answer 10

• carry sperm from the testis to the penis for ejaculation
• bigger than other vessels
• it is hard and thick

Question 11

What is the tunica vaginalis

Answer 11

• peritoneal sac covering the testis
• travels down with the testis from retroperitoneum during development
• sometimes has a connection still remaining to the abdomen called the processus vaginalis
• the sac covers only the testis not the epididymis

Question 12

What is a congenital indirect inguinal hernia and what causes it

Answer 12

• this is when bowel is pushed into the inguinal canal when a baby cries
• occurs because the processus vaginalis from the tunica vaginalis remains as a tube instead of degenerating

Question 13

What makes up the spermatic cord

Answer 13

Rule of 3s

3 coverings - external spermatic fascia, cremesteric muscle and internal spermatic fascia

3 arteries - testicular artery, cremesteric artery and the artery of the vas

3 veins - testicular veins, cresmesteric vein and the vein from the vas

3 nerves - genital branch of the genitofemoral nerve (nerve to the cremester muscle), inguinal branch of the ileoinguinal nerve (supplies sensation to the anterior 1/3 of the scrotum) and sympathetic nerves to the vas and testis

3 structures - vas deferens, lymphatics and processus vaginalis (connects peritoneal sac around testis to the peritoneal sac in abdomen)

Question 14

Which nerves supplies sensation to the anterior 1/3 of the scrotum

Answer 14

-the inguinal branch of the ileoinguinal nerve

Question 15

What is the epidydimus of the testis and what does it do

Answer 15

• runs from the top of the testis to the bottom

- connection to the testis are the ducti efferentis

Question 16

What is the tunica albuginia of the testes

Answer 16

-the white coating layer on the testis deep to the tunica vaginalis

Question 17

What is Buck’s fascia and what does it do

Answer 17

• thick fascia surrounding the penis

- limits the amount of blood that flows into the penis during an erection

Question 18

Name the 3 cylinders that form the erectile tissue of the penis

Answer 18

• 2 corpora cavernousus (end just before the glans penis and is responsible for penis being hard)
• 1 corpora spongiosus (forms the glans penis entirely and is responsible for penis being erect)

Question 19

In which erectile compartment in a male does the urethra lie

Answer 19

-the corpora spongiosum

Question 20

What is the navicular fossa

Answer 20

-the wider aspect of the urethra in the glans penis of a male

Question 21

What does the inguinal canal convey in women and how long is it

Answer 21

• the round ligament of the uterus
• the ilio-inguinal nerve (in men and women)
• about 5cm (in men and women)

Question 22

Describe the skin and superficial fascia deep to the skin

Answer 22

• skin is thin, wrinkled and darkly pigmented

- superficial fascia has no fat but contains fibres of involuntary muscles called dartos

Question 23

What are hernias referred to in relation to the inferior epigastric artery

Answer 23

• a hernia medial to the inferior epigastric artery is called a direct inguinal hernia
• a hernia lateral to the inferior epigastric artery is called an indirect inguinal hernia

Question 24

What is another name for a prepuce

Answer 24

-a foreskin

Question 25

What is a direct hernia

Answer 25

If it passes through the tranversus fascia of the posterior wall, directly through the internal oblique layer and directly through the external ring

Question 26

What is an indirect hernia

Answer 26

If the hernia passes along the length of the inguinal canal through each of the 3 layers of abdominal wall in different positions

Question 27

Where would gonadal lymph node metastasis be found

Answer 27

- lymph node metastasis located around the aorta in the upper abdomen - gonads form on the posterior abdominal wall in the embryo and migrate from the level of the kidney down to their adult position

Question 28

What is hydrocoel

Answer 28

- the testis is partially surrounded by the tunica vaginalis - disease of the testis or scrotum can cause fluid to collect in the tunica vaginalis - the tunica vaginalis swells and fees fluid, it transmits light so when a torch can be shown through it

Question 29

Give the borders of the urogenital triangle (the peroneum)

Answer 29

- along both inferior pubic rami to the ischial tuberosities | - a line from one ischial tuberosity to the other

Question 30

Give the borders of the ano-rectal triangle

Answer 30

- a line from one ischial tuberosity to the other | - the coccyx as the head of the triangle

Question 31

What membrane covers the urogenital triangle and is the attachment point for the external genitalia

Answer 31

The peroneal membrane

Question 32

What do the deep peroneal pouch form

Answer 32

- these muscles form part of the sphincters for the vagina and urethra in a female - just the urethra in a male

Question 33

What is the crura cavernosus and where does it arise

Answer 33

- it forms the foot of the column of erectile tissue (the corpora cavernosus) - arise in the groove between the peroneal membrane and the inferior pubic ramus

Question 34

What is ischio-cavernosus and where is it

Answer 34

- skeletal muscle | - over the top of the crura caverosus

Question 35

What forms the foot of the corpora spongiosus in men and what muscle overlies that

Answer 35

- the crura spongiosus | - bulbospongiosus muscle

Question 36

Describe the spongiosus in females

Answer 36

-2 bodies seperated by the interoitus 2 labia majora (hair bearing and sweat glands) 2 labia minora (no hair follicles) These 4 erectile tissue meet to form the clitoris -the hood of the clitoris is a bit of anterior labia minora

Question 37

Which nerves supply the female genitalia above and below the line just below the clitoris

Answer 37

- the skin above the line is L1 ilioinguinal nerve - the skin below the line is the S2 sacral nerve - S2 supply a ring around the anal canal - S3 a smaller ring around the anal canal - S4 a smaller ring around the anal canal - S5 a tiny ring including the distal part of the anal canal itself

Question 38

Where does the peudendal nerve pass out of and what is its clinical significance

Answer 38

- the greater sciatic foramina - sends a superficial and a deep branch to supply the peroneum - useful to inject anaesthetic during childbirth - it numbs the posterior 2/3 of the peroneum which includes the vaginal orifice where the baby comes through

Question 39

Which nerve supplies the peroneum and where does it arise

Answer 39

- the peudendal nerve | - a branch of the sacral 2, 3 and 4

Question 40

What does the peudendal nerve supply

Answer 40

- exits the greater sciatic foramina (with sciatic nerve and piriformis muscle) and enters the lesser sciatic foramina - supply the posterior 2/3 of the external genitalia - supplies the area of skin of the central buttocks - supplies the lower 2/3 of the anal canal

Question 41

Give the origin, insertion, innervation and function of the gluteus maximus muscle

Answer 41

Origin = external surface of the ilium, coccyx and (sacrotuberous ligament, sacrum and iliac crest) Insertion =iliotiial tract of fascia lata and gluteal tuberosity of proximal femur Innervation = inferior gluteal nerve L5, S1, S2 (and superior gluteal nerves) Function = extensor of flexed femur at hip joint, laterally rotates and adducts thigh

Question 42

Give the origin, insertion, innervation and function of the levator ani muscle

Answer 42

``` Origin = pubic bone, ischial spine Insertion = perineal membrane, anal canal Innervation = anterior ramus of S4, inferior rectal branch of the pudendal nerve S2 to S4 Function = forms the part of the pelvic floor (closes off the pelvic outlet), reinforces external and anal sphincter ```

Question 43

What does the sacrotuberous ligament do

Answer 43

Tbc - the peudendal nerve passes deep to the sacrotuberous ligament to enter the ischio-rectal fossa - the sacrotuberous ligament lies on top of the sacrospinous ligament

Question 44

Which ligament does the peudendal nerve run superficial to and what does this ligament do

Answer 44

- the sacospinous ligament | - tbc

Question 45

Give the origin, insertion, innervation and function of the obturator internus muscle

Answer 45

``` Origin = wall of true pelvis Insertion = medial surface of greater trochanter of femur Innervation = nerve to obturator interns L5, S1 Function = lateral rotation of extended hip joint, abduction of flexed hip ```

Question 46

The inguinal canal is a potential weakness in the anterior abdominal wall. What factors normally prevent herniation of the abdominal contents through the inguinal canal?

Answer 46

- the deep inguinal ring and the superficial inguinal ring are in different positions - the lower fibres of tranversalis and internal oblique arch over the canal and close it off during contraction of the abdominal wall

Question 47

Where would you palpate the ductus deferens? And how would you identify it by palpation alone

Answer 47

- it is easy to feel between the upper pole of the testis and superficial inguinal ring (in the spermatic cord) - feels like a hard cord but flexible - it arises at the lower pole of the testis but it is hard to feel there

Question 48

What is a varicocele

Answer 48

- high pressure of venous blood in the pampiniform plexus of veins in the scrotum causes the veins to enlarge - basically dilated veins in the pampiniform plexus

Question 49

Some indirect inguinal hernias are congenital (means present at birth) even though they may not appear until later in life. Explain the embryology of these hernias

Answer 49

- the testis develops in the posterior part of the abdomen and migrate down through the inguinal canal to lie in the scrotum - as it migrates it pulls a covering of peritoneum with it (tunica vaginalis) - normally the connection between the peritoneal cavity and the tunica vaginalis obliterates but in some cases it remains a tube (processus vaginalis - the processus vaginalis might stretch and become a hernia

Question 50

Where would you try to palpate lymph nodes to assess the spread of testicular cancer?

Answer 50

-in the epigastrium - the lymph drainage of any organ follows the arteries (but flow in the opposite direction) - cancer of the testis will spread to lymph nodes around the aorta where the testicular arteries arise

Question 51

Where might you look for an undescended testis? Is it worth surgically correcting this anomaly?

Answer 51

- testis develop just below the kidney and travel down the posterior abdominal wall through the inguinal canal and into the scrotum during inter-uterine development - spermatogenesis does not occur correctly at body temperature so the testis migrates into the scrotum where the temperature is lower - in undescended testis, correction is essential to ensure future fertility

Question 52

What anatomical structure in the glans penis might impede the progress of a catheter?

Answer 52

-the navicular fossa

Question 53

Which nerves provide sensory innervation to the scrotal skin

Answer 53

- the ilio-inguinal nerve (L1) supplies the anterior 1/3 of the scrotal skin - the pudendal nerve (S2, 3 and 4) supplies the posterior 2/3 of the scrotal skin

Question 54

Which 3 veins form the left renal veins and which structures do they drain

Answer 54

- left suprarenal -drains the adrenal glands - left renal vein (smaller one) - testicular vein - drains deep inguinal ring

Question 55

Why are tumours of the left kidney important in relation to the testicular vein

Answer 55

- tumours of the left kidney can compress the testicular vein - causing a swelling of the left testicle - may cause swelling of the veins around the testis (varicoceole)

Question 56

Which veins drain into the right side of the inferior vena cava independently in the abdomen (as opposed to the left side which join into one before draining into the inferior vena cava)

Answer 56

- right suprarenal vein - right renal vein - right testicular vein

Question 57

What are the 3 main structures within the hilum of the kidney

Answer 57

- renal vein - renal artery - ureter - also some lymphatics and sympathetic nerves

Question 58

Which 2 places do the ureter run under major vessels

Answer 58

- under the testicular artery and vein (gonadal artery and vein in women) - under the vas deferens (also called ductus deferens) (in men)

Question 59

Name the layers surrounding the kidney and their significance

Answer 59

- peritoneum - paranephric fat - renal fascia - perinephric fat - renal capsule - kidney - tumours tend to grow along the veins of the kidneys - it is clinically significant because it means tumours and infections of the kidney rarely spread into other tissues because there are too many layers to get through

Question 60

What would be a precautious action to take if a patient presents with unilateral swelling of the left scrotum

Answer 60

-an ultrasound scan of the kidney to enter it is not a tumour that is blocking the testicular vein

Question 61

Which nerve roots form a plexus between the psoas muscle and the iliacus muscle

Answer 61

-L2, L3 and L4 nerve forming the femoral nerve running into the anterior thigh

Question 62

Which nerve runs superficial to the psoas muscle

Answer 62

-the genitofemoral nerve

Question 63

Give the origin, insertion, innervation and function of the psoas muscle

Answer 63

``` Origin = fascia on the sides of the lumbar vertebra and intervertebral discs Insertion = lesser trochanter of the femur Innervation = anterior rami of L1 to L3 Function = flexion of the thigh at hip joint ```

Question 64

Give the origin, insertion, innervation and function of the iliacus muscle

Answer 64

``` Origin = upper 2/3 of the iliac fossa, sacrum Insertion = lesser trochanter of the femur Innervation = femoral nerve L2 to L4 Function = flexion of the thigh at the hip joint ```

Question 65

Which muscle runs runs from the lower border of the 12th rib to the upper part of the pelvis

Answer 65

-quadratus lumborum

Question 66

Give the origin, insertion, innervation and function of the quadratus lumborum muscle

Answer 66

``` Origin = iliac crest, iliolumbar ligament, tranverse process of L5 Insertion = inferior border of 12th rib, transverse process of L1 to L5 vertebra Innervation = anterior rami of T12 and L1 to L4 Function = depresses and stabilises rib 12, lateral bending of the trunk ```

Question 67

Where are the lateral, medial and median arcuate ligaments (lines) and what are their significance

Answer 67

Later arcuate ligament = back wall of retroperitoneum Medial arcuate ligament = medial side of the spine in the retroperitoneum Median arcuate ligament = just in front of the aorta - the lateral ligament is where the quadratus lumborum meets the diaphragm in the retroperitoneum - the medial arcuate ligament shows where the diaphragm meets the psoas muscle - the median arcuate line is where the diaphragm passes in front of the aorta

Question 68

Which nerve does L1 divide to create

Answer 68

- the iliohypogastric nerve - the ilio-inguinal nerve -supply the area above the pubis

Question 69

Which nerve rises from the lateral border of the psoas muscle, the nerve passes underneath the inguinal ligament. What does the nerve do

Answer 69

- lateral cutaneous nerve of the thigh | - supplies the lateral part of the thigh with sensation

Question 70

Where can the obturator nerve be found

Answer 70

-on the medial side of psoas

Question 71

Describe the bifrucation of the aorta to the level of the femoral artery

Answer 71

- aorta bifurcation at the level of the umbillicus - common iliac arteries - internal and external iliac arteries - external iliac artery runs on the medial side of psoas major msucle - external iliac artery passes underneath the inguinal ligament to become the femoral artery - external iliac artery gives off the inferior epigastric artery before it becomes the femoral artery - the internal iliac artery becomes the anterior internal iliac artery and the posterior internal iliac artery - anterior internal iliac artery supplies the bladder and the uterus in the female and the placenta in the foetus - posterior internal iliac artery passes out into the buttocks to form the superior gluteal arteries and inferior gluteal arteries - the superior and inferior gluteal arteries supply blood to the buttocks and anastomose with the profuno-femoral artery at the back of the thigh

Question 72

Where do umbilical arteries (medial umbilical ligaments arise) from

Answer 72

-the anterior branch of the internal iliac arteries

Question 73

What does the obturator nerve do

Answer 73

- supplies sensation to the medial part of the thigh down to the knee - motor supply to the medial compartment of the thigh

Question 74

What are the dimensions of the kidney (length, width and thick)

Answer 74

11cm long 7cm wide 4cm thick

Question 75

What does extraperitoneal and retro-peritoneal mean and how do these relate to the kidneys

Answer 75

- extraperitoneal means outside the peritoneum - retro-perioneal means behind the peritoneal cavity -the kidneys are extra-peritoneal and retroperioneal

Question 76

How many arteries and veins supply the suprarenal glands (adrenal glands)

Answer 76

3 arteries - inferior phrenic artery gives off the superior suprarenal artery - middle suprarenal artery - inferior suprarenal artery 1 vein -suprarenal vein

Question 77

What do the genital and femoral branches of the genitofemoral nerve do

Answer 77

- the genital branch passes through the deep inguinal ring and supplies the cremester muscle (when the inside of the thigh is tickled, the testis retract) - the femoral branch passes under the inguinal ligament and is sensory to the inside of the thigh

Question 78

Give the 3 points where renal calculi (stones) might get stuck in the ureter

Answer 78

- where the pelvis of the kidney becomes the ureter - at the pelvic brim - where the ureter passes into the bladder wall

Question 79

What is the function of the psoas muscle

Answer 79

-flexor of the hip

Question 80

How can inflammation of the appendix affect the psoas muscle

Answer 80

- the appendix might lie on the psoas muscle and can be inflammed causing the psoas muscle to spasm - the psoas muscle is a hip flexor - so the patient will have a flexed hip and trying to extend the hip will cause pain

Question 81

What is a duplex ureter and how does it contribute to recurrent urinary tract infections

Answer 81

- in duplex ureters, the valve the bottom of he ureter does not function - so during micturition, urine passes back up the ureter into the kidney - during a urinary tract infection, it is easy for urine to pass up to the kidney - urine is also never completely expelled as there is always infected urine passing up the ureter which continually re-infects the bladder

Question 82

Renal tumours can become very large before they invade adjacent structures, which anatomical features explain this

Answer 82

- thick and resilient capsule - surrounded by renal fibrous capsule, perinephric fat (or perirenal fat) then the renal (perinephri fascia which encloses the kidney and adrenal glands together)

Question 83

Describe two common variations in the anatomy of the renal pelvis and ureter

Answer 83

- duplex system - pelvoureteric junction obstruction - two ureters can arise from the same kidney, they can join and enter the bladder together or can separately enter the bladder - if there are two ureters there may be two separate kidneys on that side - the upper kidney would drain normally at the trigone of the bladder but he lower kidney would drain higher up on the bladder - so the ureter of the lower kidney would not valve mechanism so urine would pass back up into the kidney when the bladder contracts

Question 84

What veins do the right and left gonadal veins drain into

Answer 84

- left gonadal vein drains into the renal vein | - right gonadal vein drains directly into the inferior vena cava

Question 85

What is a polar artery and why do they exist

Answer 85

- a polar artery is an accessory renal artery usualy supplying the lower pole of the kidney - the kidney develops as lots of kidneys with their individual arteries - these kindeys fuse and their arteries join to form a single renal artery - about 1/4 of people have two renal arteries to one kidney, a large renal artery and a smaller one to the inferior pole of the kidney

Question 86

What is clinical complication that could arise with a polar artery

Answer 86

-a polar artery can compress the ureter and stop urine flow

Question 87

Where would you palpate an abdominal aortic aneurysm?

Answer 87

-the aorta finishes just above the umbilicus so can only be felt in the upper abdomen

Question 88

Describe the relationship of the ureter to bony landmarks of the abdomen and pelvis (useful for finding the ureter on an x-ray)

Answer 88

- pelvis of the right kidney is at L3 - pelvis of the left kidney is L2/3 - the ureter starts at the lower part of the pelvis and run down the tips of the transverse processes of the lumbar vertebra - the ureter runs medial to the sacroiliac joint or directly over it - the ureter runs across the spinous process of the pelvis and medially to the bladder

Question 89

How many ossification centres is the hemi-pelvis (innominate bone) made from and where are they connected

Answer 89

- 3 separate ossification centres that fuse at the end of puberty - connected at the midline (pubis symphysis -secondary cartiliginous joint) - connected posteriorly at the 2 sacro-iliac joints (fibrocartilage and synovial cavity)

Question 90

Give the different parts of the pubic bone

Answer 90

- superior pubic ramus - pubic tubercle - body of the pubis - 1st 1/3 of the inferior pubic ramus

Question 91

Which bone contains the 2/3 of the inferior pubic ramus

Answer 91

-the ischium

Question 92

How many bones make up the hemi-pelvis

Answer 92

3 - ilium - pubic bone - ischium

Question 93

At what intervertebal level does the intercristal plane lie and what is the clinical significance

Answer 93

- between L4 and L5 | - allows us to know where to put needles for epidurals

Question 94

What cartilage lies in the sacoiliac joints of the pelvis and what is the clinical significance

Answer 94

- fibrocartilage - synovial joint - prone to rheumatoid arthritis which is a disease of the synovium

Question 95

Where do the ischiosacral ligament and spinosacral ligament extend to and from

Answer 95

- from the ischial tuberosity to the sacrum - ischiosacral ligament - from the spinous process to the sacrum - spinosacral ligament

Question 96

Which ligament creates the greater sciatic foramina

Answer 96

-the sacrotuberous ligament (ischiosacral ligament)

Question 97

Which ligaments create the lesser sciatic formina

Answer 97

- the sacrotuberous ligament (ischiosacral ligament) | - the sacrospinous ligament (spinosacral ligament)

Question 98

Why is the angle between the inferior pubic rami of a male a "V" shape

Answer 98

- so the crura of the penis (ischiocavernosus) attached along the "V" passes into the shaft of the penis - the angle needs to be as straight a line as possible to avoid damage to the penis and its attachments during intercourse

Question 99

Give the differences between the male and female pelvis

Answer 99

- the male pelvis has a straight V shape of the inferior pubic rami - the spine of the ischium points to the sacrum and is a short distance between them (for strength- allows greater amount of weight to pass through the ligaments supporting the upper body mass of the male) - prominent lumbo-sacral junction (supporting the weight of the vertebral column unto the sacrum) - in women both are the opposite to allow easier delivery of babies - no prominence to the lumbo-sacral junction giving a round/oval pelvic outlet

Question 100

Why is there a space anteriorly in the levator ani muscle

Answer 100

- in men and women for the passage of the urethra | - in women for the passage of the vagina

Question 101

Which structures support the urogenital triangle

Answer 101

- the levator ani muscles - the perineal membrane - the deep and superficial peroneal pouches

Question 102

What structures does the posterior of the bladder lie against in males and females

Answer 102

In males - front of the rectum | In females - upper 1/3 of the vagina and part of the cervix

Question 103

Is there any structure between bladder and rectus abdominis muscle and what is the clinical significance

Answer 103

- there is no structure between the bladder and rectus abdominis muscle - so when the bladder is full they are directly touching - it is clinically significant because in children, urine samples can be obtained by passing a needle through the lower abdominal wall - or if a catheter cannot be put into the urethra, it can be passed directly through the lower abdominal wall into the bladder

Question 104

What are rugae and which structures have them

Answer 104

- rugae is when there is more lining than the size of the organ so the lining is thrown into folds - the bladder and stomach

Question 105

Which nerve passes medially to the psoas

Answer 105

- obturator nerve | - deep to the obturator nerve is the lumbosacral trunk

Question 106

Name the pouches between the bladder and the structures behind it in males and females

Answer 106

Males - recto-vesical pouch Female - utero-vesical pouch anterior to the uterus - recto-uterine pouch (pouch of Douglas) posterior to the uterus

Question 107

Explain what occurs in benign prostatic hypertrophy, does it require catheterisation

Answer 107

- the prostate gland completely encircles the urethra - with progressing age, the prostate tissue enlarges (hypertrophy) and can completely block the urethra and cause an inability to pass urine -require emergency catheterisation

Question 108

Give a possible way prostate cancer metastasis can occur

Answer 108

- venous drainage of the prostate passes into a plexus of veins which lie anterior to the sacrum and communicate with veins which run up to the azygous veins in the chest - these veins communicate with veins in the vertebral bodies and do not have valves so blood can flow in either direction - during inspiration, the negative pressure in the chest sucks blood up the veins but during expiration gravity pulls it back down again - tumour cells travel up the veins and then pass down into the vertebral bodies where they may attach and cause a metasis

Question 109

What are the 3 components of micturition (passing urine)

Answer 109

- control of the brain - control from the spinal cord - sensory input from the bladder

Question 110

How does loss of the brain control aspect in micturition present and why, is there a risk of renal failure

Answer 110

- bladder fills - spinal cord knows bladder is full and asks brain permission to empty - brain does not reply - spinal causes the bladder to empty - patient suddenly and unexpectantly passes urine with no control - there is low pressure in the bladder so no risk of renal failure

Question 111

How does loss of the sensation aspect in micturition present and why, is there a risk of renal failure

Answer 111

- spinal cord and brain cannot know that bladder is full as no sensation so cannot tell it to empty - bladder fills up - patient continually dribbles urine - high pressure in the bladder and kidney which rapidly progresses to kidney damage and failure

Question 112

How does loss of the spinal control aspect in micturition present and why, is there a risk of renal failure

Answer 112

- patient knows bladder is full but cannot empty it | - high pressure in bladder and kidney so causes renal failure

Question 113

How is a prostate examination carried out and why is possible

Answer 113

- through the anal canal | - the prostate lies immediately anterior to the rectum

Question 114

Where do the femoral, obturator and sciatic nerves pass from the abdomen into the thigh

Answer 114

Femoral - under the inguinal ligament halfway between the pubic tubercle and anterior superior iliac spine Obturator - through the obturator foramina (canal) Sciatic - through the greater sciatic foramen into the buttock and then thigh

Question 115

Why is the ureter in danger of damage during a hysterectomy (removal of the uterus)

Answer 115

-the uterus runs immediately under the uterine artery which needs to be ligated and divided to complete the hysterectomy

Question 116

What stops urine passing from the bladder back up the ureter

Answer 116

- the ureter enters the bladder at an oblique angle forming a flap valve - as pressure increases in the bladder, the angle presses on the part of the ureter which is in the bladder wall and stops urine passing back up to the kidney

Question 117

Where does the bladder lie when full

Answer 117

- the fundus of the bladder lies immediately above the pubis symphysis and there is no peritoneum between the abdominal wall and bladder - against the lower abdominal wall with no peritoneum between the bladder and the abdominal wall

Question 118

A 25 year old woman involved in a car crash suffered complete transection of her spinal cord at the level of T6. Is she able to tell when her bladder is full? Does her bladder empty via muscle contraction or does it simply overflow? Will her bladder completely empty?

Answer 118

She cannot tell when her bladder is full as the signals cannot reach her brain (no sensation) Her bladder empties by muscle contraction controlled by a spinal micturition reflex in the sacral part of the spinal cord (S2 to S4) Her bladder will completely empty because it empties by contraction - the spinal micturition reflex process - as the bladder fills it is detected by the sensory nerves entering the cord at S2-4 - once the bladder is sufficiently full these sensory nerves stimulate the motor nerve to contract the detrusor muscle and relax the sphincters - same reflex is found in pre-potty trained children - once micturition is initiated, it cannot be suppresed

Question 119

What is the action of psoas muscle

Answer 119

-flexion of the hip joint

Question 120

Give the origin, insertion, innervation and function of psoas minor

Answer 120

``` Origin = bodies of T12 and L1 vertebra Insertion = pelvic brim and iliopubic eminence Innervation = anterior rami of L1 Function = weak flexion of lumbar vertebral column ```

Question 121

Where are the internal and external bladder sphincter

Answer 121

- the internal bladder is at the bladder neck at its base, just on top of the prostate gland, at the start of the urethra - the external bladder sphincter is just below the prostate gland and is part of the peroneum

Question 122

Which part of the prostate gland is prone to malignancy

Answer 122

-the peripheral part

Question 123

Which part of the prostate gland is prone to hypertrophy

Answer 123

-the central part of the prostate gland

Question 124

If the uterus is bent forwards compared to the vagina, it is called

Answer 124

Anteverted

Question 125

If the uterus is bent backwards compared to the vagina, it is called

Answer 125

Retroverted

Question 126

If the uterus itself is bending forward but its body is straight with the vagina, it is called

Answer 126

Anteflexed

Question 127

If the uterus itself is bending backwards while its body is straight with the vagina, it is called

Answer 127

Retroflexed

Question 128

What is the narrowing at the outlet of the cervix called

Answer 128

-the external os

Question 129

Which structure marks the start of the uterine cavity

Answer 129

-the internal os

Question 130

What is the space slightly behind, lateral and in front of the cervix called

Answer 130

- the posterior fornix - the anterior fornix - the lateral fornix

Question 131

Why is the posterior fornix clinically important

Answer 131

- the posterior fornix is close to the peritoneal cavity - so a needle can be inserted into the vagina through the posterior fornix and into the peritoneal cavity to harvest eggs from the ovaries at the back of the uterus by the ligament of the ovary and covered in mesovarium (broad ligament)

Question 132

What does the Pouch of Douglas contain

Answer 132

-the sigmoid colon or small bowel

Question 133

Where and what is the broad ligament

Answer 133

- lateral side of the uterus | - double fold of peritoneum

Question 134

Which structure runs along the upper limits of the broad ligament

Answer 134

-the fallopian tube

Question 135

Where are the ovaries found

Answer 135

-attached to the back of the uterus by the ligament of the ovary and covered in mesovarium (broad ligament)

Question 136

Where does the round ligament of the uterus run

Answer 136

-from the uterus into the inguinal canal and through the deep inguinal ring to the labia majora

Question 137

If a tumour of the ovary metasises via lympahtics where would it be found

Answer 137

- the lymphatics follow the ovarian artery to the aorta (just like with the testicular artery) - the metastases will occur around the aorta at the level of the kidneys

Question 138

Which structures make up the ovarian fossa and what is the clinical significance of on of these sturctures

Answer 138

- between the internal iliac (artery/vein) and external iliac (artery/vein) with the obturator nerve in the middle - the ovary will lie in front of this fossa - diseases of the ovary can irritate the obturator nerve which supplies the inside of the lower thigh - so the patient will feel pain on the inside of the lower thigh even though they have a disease within the ovarian fossa

Question 139

Which artery does the uterine artery come off

Answer 139

-the internal iliac artery

Question 140

Which vessel does the uterine artery anastomose with and why is this neccessary

Answer 140

- ovarian arteries - neccessary during preganancy as the uterine arteries cannot supply all the blood supply for full development of the foetus on their own

Question 141

Which ligament holds the uterus in a midline position

Answer 141

-the broad ligament (runs from the lateral wall of the pelvis to the lateral wall of the uterus)

Question 142

Which ligaments support the cervix and where do they attach to

Answer 142

- cardinal ligaments (also called pelvic fascia) - run from the lateral wall of the cervix to the lateral pelvic side at the base of the broad ligament - pelvic floor, bones of the sacrum and pelvic ring

Question 143

Can the urethra and rectum prolapse into the vagina, which other structure can prolapse into the vagina and why

Answer 143

- yes | - the cervix can prolapse into the vagina especially in women who have had multiple vagina delivery and are old

Question 144

By manual examination through the vagina, which structures can be examined

Answer 144

- the wall of the bladder - the urethra - the wall of the rectum - anal canal - Pouch of Douglas - bimanual examination might allow the palpation of a particularly large ovarian cyst

Question 145

Testicular pain may radiate to the loin why?

Answer 145

- the nociceptive nerve fibres (pain sensation) to the testis are sympathetic and follow the testicular artery from the aortic sympathetic plexus - nerve fibres to the testis are from the T11 and T12 nerve roots - pain is felt in the distribution of the cutaneous nerve of these segments as referred pain

Question 146

Which muscle maintains the angle between the anal canal and rectum

Answer 146

- levator ani is the whole sheet of muscle | - the anterior fibres of the levator ani called puborectalis maintain the angle

Question 147

What are the parts of the uterus

Answer 147

- fundus - body - cervix

Question 148

How long is the uterus

Answer 148

-8cm long

Question 149

What is the normal position of the uterus

Answer 149

-anteflexed and anteverted

Question 150

What are the structures between the cervical canal and the vagina and the uterus

Answer 150

- internal os is between the cervix and the uterus | - external os is between the cervix and vagina

Question 151

How long are the uterine tubes (fallopian tube)

Answer 151

10cm

Question 152

Which ligament keeps the ovary in the right position near the fimbriae of the fallopian tubes

Answer 152

Suspensory ligament of the ovary

Question 153

Where does the vagina terminate

Answer 153

-the introitus (vaginal orifice)

Question 154

Where does the upper 2/3 of the vagina lie

Answer 154

-pelvic cavity

Question 155

Where does the lower 1/3 of the vagina lie

Answer 155

-in the perineum

Question 156

What is the mons pubis

Answer 156

-rounded hair bearing area of skin covering the front of the pubic symphysis

Question 157

What is the vestibule of the vagina

Answer 157

-the area between the labia minora

Question 158

How many bundles of erectile tissue make up the clitoris

Answer 158

-3 just like penis

Question 159

At the back of the bladder, the ductus deferens joins the duct of which vessel to form the ejaculatory duct

Answer 159

-the seminal vesicles

Question 160

Where is the ampulla of the ductus deferens found

Answer 160

-on the posterior aspect of the bladder

Question 161

In urinary retention, the emergency treatment is catheterisation. Give 3 places where it may be difficult to pass a catheter

Answer 161

- the navicular fossa of the glans of the penis - the perineal membrane (which is fixed while the distal urethra is flexible), the urethra has to be pulled out to length to make it taught to allow a catheter to pass - the bladder neck with the internal sphincter

Question 162

What can cause urinary incontinence (inability to store urine)

Answer 162

- neurological control of micturition - muscle weakness - vaginal hernias

Question 163

Which structures can herniate through the vagina

Answer 163

- uterus (uterine prolapse) - bladder (cystocele) - urethra (urethrocele) - rectum (rectocele)

Question 164

How can sexually acquired infection cause pelvic inflammatory disease

Answer 164

- sexually acquired infection can spread from the vagina into the uterus to the fallopian tube - the fallopian tube open directly into the peritoneal cavity so the infection can spread to the pelvic part of the cavity - causing pelvic inflammatory disease

Question 165

Why may inflammation of the ovary cause pain along the medial aspect of the thigh

Answer 165

-the ovary sits alongside the lateral pelvic side wall where the obturator nerve runs, irritation of the nerve leads to medial thigh pain as referred pain

Question 166

What is a retroverted uterus

Answer 166

- the uterus usually lies tilted forwards over the bladder - retroversion is when it lies further away from the bladder and may impinge on the anterior wall of the rectum or sacrum

Question 167

What maintains the normal position of the uterus

Answer 167

- tone in the levator ani muscles - transverse cervical ligaments (cardinal) - pubocervical ligaments - sacrocervical ligaments - broad ligaments

Question 168

To which lymph nodes would cervical cancer spread

Answer 168

- the blood supply to the cervix is from the internal iliac arteries - the main lymph nodes along these arteries would be involved in the spread of cervical malignancy

Question 169

What structures may be palpable during a vaginal examination

Answer 169

Anteriorly - base of bladder - urethra - lower ureters (if they contain a stone) Laterally - ureter - levator ani muscles - ovary (by bimanual palpitation) Posteriorly - rectum - pouch of Douglas - perineal body

Question 170

What is the superficial perineal pouch

Answer 170

-area of the perineum superficial to the urogenital diaphragm

Question 171

What is the perineal membrane

Answer 171

-superficial layer of fascia covering the urogenital diaphragm

Question 172

What is the urogenital diaphragm

Answer 172

-tissues forming a triangle of tissue closing the anterior pelvic outlet

Question 173

If there was a rupture of the penile urethra where would the urine collect

Answer 173

-superficial perineal pouch

Question 174

Give the difference between the muscles of the forearm closer to the wrist and closer to the elbow

Answer 174

-closer to the elbow, the muscle becomes more adherent to the surface of the deep fascia and the bone

Question 175

How many muscles layers are there of the flexor compartment of the forearm

Answer 175

Superficial tendon - palmaris longus (middle tendon - superficial to the flexor retinaculum) - flexor carpi radialis (on radial side - attached to wrist bone) - flexor carpi ulnaris (on ulna side - also attached to wrist bone) - pronator teres Middle compartment -flexor digitorum superficialis (group of 4 tendons in one, flexes the proximal interphalangeal joint in the fingers) Deep compartment - flexor digitorum profundus (group of 4 tendons in one, deep to the superfiscialis one, flexes the distal interphalangeal joint) - flexor pollicis longus (flexes the thumb) - pronator quadratus (quadraletral muscle)

Question 176

Give the origin, insertion, innervation and function of the pronator teres muscles

Answer 176

Origin = medial epicondyle of the humerus Insertion = halfway down the radius Innervation = Function = pronates the forearm

Question 177

Give the origin, insertion, innervation and function of the palmaris longus muscles

Answer 177

Origin = medial epicondyle of the humerus Insertion = Innervation = Function =

Question 178

Give the origin, insertion, innervation and function of the palmaris brevis muscles

Answer 178

Origin = Insertion = Innervation = Function = Small muscle on side of the palm

Question 179

Give the origin, insertion, innervation and function of the flexor carpi radialis muscles

Answer 179

Origin = medial epicondyle of the humerus Insertion = Innervation = Function = flex the wrist

Question 180

Give the origin, insertion, innervation and function of the flexor carpi ulnaris muscles

Answer 180

Origin = medial epicondyle of the humerus Insertion = Innervation = Function = flex the wrist

Question 181

Give the origin, insertion, innervation and function of the flexor digitorum superficialis muscles

Answer 181

Origin = Insertion = Innervation = Function =

Question 182

Give the origin, insertion, innervation and function of the flexor digitorum profundus muscles

Answer 182

Origin = Insertion = Innervation = Function =

Question 183

Give the origin, insertion, innervation and function of the flexor pollicis longus muscles

Answer 183

Origin = Insertion = base of the terminal phalanx of the thumb Innervation = Function =

Question 184

Give the origin, insertion, innervation and function of the pronator quadratus muscles

Answer 184

Origin = Insertion = Innervation = Function = pronate the forearm

Question 185

Describe the journey of the median nerve in the wrist

Answer 185

-runs through the carpal tunnel

Question 186

Describe the journey of the ulna artery and nerve at the wrist, is there a risk of damage and compression

Answer 186

-ulna artery and nerve runs on the side of the ulna and do not go through the carpal tunnel -less risk of damage and compression Lies lateral to the pisiform

Question 187

Describe the journey of the radial artery at the wrist, is there a risk of damage and compression

Answer 187

- radial artery run on the radial side - sit on bone - lies lateral to the flexor carpi radialis

Question 188

Which veins make up the dorsal venous arch on the back of the hand

Answer 188

- cephalic vein | - basilar vein

Question 189

Which nerve supplies the anterior part of the arm

Answer 189

-the musculocutaneous nerve

Question 190

Which nerve supplies the posterior aspect of the arm and forearm

Answer 190

-radial nerve

Question 191

Which nerve supplies the anterior compartment of the forearm

Answer 191

- majorly supplied by the median nerve - two muscles supplied by the ulna nerve (flexor carpi ulnaris and medial half of flexor digitorum profundus) -the ulna nerve only supplies the flexor digitorum profundus to the little finger and ring finger

Question 192

Give the origin, insertion, innervation and function of the brachioradialis muscle

Answer 192

``` Origin = lateral supracondylar ridge of the humerus Insertion = distal end of the radius just above its styloid process Innervation = radial nerve Function = flexor of the elbow ```

Question 193

Where can the ulna nerve be damaged

Answer 193

- at the elbow where it passes behind the medial epicondyle of the humerus - at the wrist where it lies superficially lateral to the pisiform bone

Question 194

Which nerve is not affected by carpal tunnel syndrome

Answer 194

-the ulna nerve

Question 195

Which structures form the carpal tunnel

Answer 195

- flexor retinaculum | - carpal bones of the wrist

Question 196

Which structures pass through the carpal tunnel

Answer 196

- median nerve - 8 flexor tendons for the fingers (from flexor digitorum superficialis and flexor digitorum profundus) - flexor pollicis longus

Question 197

Explain carpal tunnel sydrome

Answer 197

- swelling of the 8 tendons or arthritis affecting the joints of the carpal bones can increase pressure in the tunnel which will compress the median nerve - manifests as pain and diminished sensation on the skin along the distribution of the median nerve - may also be weakness of the hand muscles supplied by the median nerve

Question 198

Explain Colles fracture

Answer 198

- to break their fall, many people put their hand out - this leads to a fracture of the distal end of the radius - falls are common in elderly people - elderly women are more at risk as a reduction in oestrogen after menopause leads to weaker bones (osteoporosis) - can lead to carpal tunnel syndrome

Question 199

Explain De Quervain's syndrome (repetitive strain injury)

Answer 199

- the synovial sheath of the tendons of the wrist become inflamed and painful - common in those repeating the same movements over and over e.g typing on a keyboard

Question 200

What is a "ganglion" in terms of the wrist

Answer 200

- when synovium undergoes hypertrophy and the excess synovium and excess liquid present as a soft squidgy bulge - often near the dorsal aspect of the wrist

Question 201

What are the 3 superficial veins of the forearm and where do they run

Answer 201

- cephalic vein - basilic vein - antecubital vein - cephalic vein runs from the lateral side of the dorsal venous arch over the radius up to the antecubital fossa to give off the antecubital vein - continues in the groove between the triceps and the biceps on the lateral side of the arm till it reaches the deltoid - runs in the deltopectoral groove to below the clavicle where it passes into the axillary vein - basilar vein runs from the medial side of the dorsal venous arch and runs over the ulna till the antecubital fossa - joins the antecubital vein and passes on the medial side between the triceps and biceps to become the brachial vein

Question 202

What are three major nerves entering the forearm and what do they supply

Answer 202

- radial nerve - median nerve - ulna nerve radial -motor to posterior compartment of forearm and skin on the lateral part of the back of the hand median - motor to all flexors of the forearm except flexor carpi ulnaris and the medial fingers of the flexor digitorum profundus - motor to the LLOAF muscles of the hand which are opponense pollicis, abductor pollicis brevis, flexor pollicis brevis - skin on the lateral 3.5 digits on the palm of the hand Ulna - motor to flexor carpi ulnaris and medial fingers of flexor digitorum profundus - motor to all muslces in hand except LLOAF - skin on the medial 1.5 digits on palm of the hand

Question 203

Where is the common flexor origin

Answer 203

-medial epicondyle of the humerus

Question 204

How do you test the muscles supplied by the median nerve

Answer 204

- flexion of the thumb and lateral two fingers | - movement of the thenar muscles

Question 205

Where can you palpate the brachial, radial and ulna arteries | Which is easier to palpate and why

Answer 205

Brachial - medial to the biceps aponeurosis Ulna - lateral to the pisiform or just proximal to this position Radial -lateral to the most lateral tendon at the wrist -the radial artery is the easiest to palpate because it s superficial and has bone directly behind it

Question 206

Where does the brachial artery and median nerve pass into the forearm

Answer 206

-median to the biceps aponeurosis

Question 207

How many carpal bones from the wrist and what are they

Answer 207

8 From the radius - scaphoid - lunate - triquetrum - pisiform - hamate - capitate - trapezoid - trapezium

Question 208

Why is the blood supply of the scaphoid important (explain the avascular necrosis of the scaphoid)

Answer 208

- scaphoid started embryologically as two separate bones but fused together to form a single bone - the artery supply to the medial (proximal)side of the scaphoid disappeared leaving only one blood supply to the bone - if you fall on the bone and fracture it down its midline, the medial (proximal) aspect might die - this will cause dysfunction at the wrist joint

Question 209

Does the palmaris longus lie on top or through the flexor retinaculum

Answer 209

-on top of flexor retinaculum

Question 210

What allows the lack of movement of the skin of the palm of the hand

Answer 210

- the palmar fascia (palmar aponeurosis) | - makes it easy to grip things

Question 211

What is the hypothenar eminence

Answer 211

- abductor digiti minimi - flexor digiti minimi brevis - opponens digiti minimi

Question 212

What does the thenar eminence consist of

Answer 212

3 of them - abductor pollicis brevis - flexor pollicis brevis - opponense pollicis

Question 213

Which artery form the superficial palmar arch and what does the superficial palmar arch supply

Answer 213

- ulna artery - supplies majority of the hand - superficial palmar arch supply blood to the fingers

Question 214

Which artery passes through the anatomical snuff box

Answer 214

-the radial artery

Question 215

Where is the 1st web space and which artery passes through it

Answer 215

- between the 1st and 2nd metacarpal through the muscle | - the radial artery

Question 216

Which artery forms the deep palmar arch and where is the deep palmar arch

Answer 216

- the radial artery | - between the tendon and bones

Question 217

Where is the venous drainage of the hand

Answer 217

-on the back of the hand

Question 218

Where do the lumbricals attach and insert ad what do they do

Answer 218

Origin = flexor digitorum profundus of each phalanx Insertion = dorsal digital expansion on posterior of the finger Innervation = two lateral lumbericals supplied by the median nerve and two medial lumbricals supplied by the ulnar nerve Function = used to simultaneously flex the metacarpophalangeal joit while extending the interphalangeal joints -so making an upstroke while writing - starts in the palm and travels across the metacarpalphalangeal joint - they attach to the profundus tendon on the finger - travel round the finger to insert on the extensor on the posterior (dorsal) aspect - when they contract they pull the profundus tendon superiorly (check this line) - bends the metacarpalphalangeal joint and straighten the 2 higher interphalangeal joints

Question 219

What allows the tendons in the fingers to freely slide

Answer 219

-synovial membrane producing synovial fluid

Question 220

What is a retinaculum and what does it do

Answer 220

- also called fibrous flexor sheath - it is a sheath that covers the tendons of the fingers at a joint to prevent them pulling away from the bone when the finger is flexed

Question 221

Which flexor of the digits(fingers) divides into two and passes round the other tendon to insert on the middle phalanx

Answer 221

-the flexor digitorum superficialis

Question 222

What are the vincula and what are their purpose

Answer 222

- loose connections between the tendons of the flexor digitorum superficialis and profundus - it is how the tendons get their blood supply - they are lined with synovium

Question 223

Give the origin, insertion, innervation and function of the abductor pollicis brevis muscle

Answer 223

``` Origin = flexor retinaculum Insertion = lateral aspect of the first phalanx of the thumb Innervation = median nerve Function = pulls the thumb away from the palm of the hand ```

Question 224

Give the origin, insertion, innervation and function of the flexor pollicis brevis muscle

Answer 224

Origin = Insertion = lateral aspect of the first phalanx of the thumb Innervation = median nerve Function = flex the thumb joint

Question 225

Give the origin, insertion, innervation and function of the opponens pollicis muscle

Answer 225

``` Origin = shaft of the metacarpal Insertion = carpus Innervation = median nerve Function = rotates the thumb so it can pinch the tips of fingers (opposition) ```

Question 226

Give the origin, insertion, innervation and function of the adductor pollicis muscle

Answer 226

Origin = Origin = Insertion =medial aspect of the first phalanx Innervation = ulnar nerve Function = pull the thumb towards the palm of the hand

Question 227

Give the origin, insertion, innervation and function of the abductor digiti minimi muscle

Answer 227

Origin = pisiform bone Insertion = proximal phalanx Innervation = Function = pulls little finger away from the ring finger

Question 228

Give the origin, insertion, innervation and function of the flexor digiti minimi muscle

Answer 228

Origin = Insertion = proximal phalanx Innervation = Function = flex the metrcarpophalangeal joint

Question 229

Give the origin, insertion, innervation and function of the opponens digiti minimi muscle

Answer 229

Origin = carpal bone Insertion = whole shaft of metacarpal Innervation = Function = rotates the metacarpal so tip of the little finger faces the thumb (opposition)

Question 230

Give the origin, insertion, innervation and function of the dorsal interosseus muscle

Answer 230

Origin = Insertion = proximal phalanx of the finger Innervation = Function = pulls the index finger away from the middle finger

Question 231

What are the web spaces of the hand

Answer 231

-basically the bottom of the space between the fingers

Question 232

How many dorsal interosseus muscles are there

Answer 232

4 Attached to lateral aspects of fingers

Question 233

Give the actions of the four dorsal interosseous muscles

Answer 233

1- moves index finger away from middle finger 2 -moves middle finger towards index finger 3 - moves middle finger towards ring finger 4 - moves ring finger away from middle finger DAB Dorsal interosseus ABduct

Question 234

How many interossues muscle are there on the palm of the hand

Answer 234

3 -attached to medial aspect of finger

Question 235

What are the actions of the 3 ventral interosseus muscles

Answer 235

1- pull index finger towards the middle finger 2- pull rings finger towards the middle finger 3- pulls little finger towards the middle finger PAD Palmar interossei ADDuct

Question 236

What does LLOAF stand for

Answer 236

L - lateral two lumbricals (near the thumb) O - Opponens pollicis A - Abductor pollicis brevis F - Flexor pollicis brevis -these are all supplied by the median nerve

Question 237

In the hand what does the ulna nerve supply (motor)

Answer 237

- all motor except LLOAF - so all the dorsal and ventral interossei - the median lumbricals (the one close to the little finger) - the hypothenar eminence muscles

Question 238

In the hand, what does the ulna nerve supply (sensory)

Answer 238

- all the little finger | - later half of anterior and posterior of the ring finger

Question 239

In the hand, what does the median nerve supply (sensory)

Answer 239

- anterior of the thumb, index, middle and medial half ring finger and the according part of the palm - the posterior tip of the thumb, index, middle and medial half of ring finger (above the distal phalangeal joints)

Question 240

In the hand, what does the radial nerve supply

Answer 240

-the posterior of the thumb, index, middle and the medial half of the ring finger except their tips (below the distal phalangeal joints)

Question 241

What can cause tenosynovitis of the hand and how

Answer 241

- penetrating injuries (like thorns) of the fingers | - introduces infection to the retinaculum (fibrous sheath and synovial sheath) of the finger

Question 242

How is the precision grip (also called pincer's grip) f holding a pen is produced and which muscles are involved

Answer 242

- abductor pollicis brevis - flexor pollicis brevis - opponens pollicis - adductor pollicis - the thumb is first abducted and flexed - then medially rotated at the carpometacarpal joint (so it is opposed) - the adductor pollicis is used to exert pressure on the object

Question 243

Will injuries to nerves at the wrist result in total palmar sensory loss

Answer 243

- sensation of the palm of the fingers will be affected - may not result in total sensory loss because the cutaneous branches of the median and ulnar nerves are given off in the foream

Question 244

Explain Dupuytren's contracture

Answer 244

- when the palmar fascia progressively scars and leads to shortening of the fascia - pulls affected fingers into flexion until fingers are tightly held against the palm - rendering the hand totally useless - common in manual workers - the palmar fascia arises from the flexor retinaculum and attaches to the flexor sheath of each finger

Question 245

Where does the palmar fascia arise and attach to

Answer 245

- arises from the flexor retinaculum | - attaches to the flexor sheath of each finger

Question 246

Explain trigger fingers syndrome

Answer 246

- when the tendon sheaths holding the tendons of each finger to the bone becomes narrowed, damaged or swollen - the tendon cannot slide freely - the tendon will catch and suddenly pull through like the trigger of a gun - this is because of the steady increase of pressure of the muscle

Question 247

Explain the gameskeeper's thumb (also called skier's thumb)

Answer 247

- when the thumb is rapidly forced away from the hand - this may rupture the medial ligament of the thumb - causes instability of the joint and any grip using the thumb is weaker eg picking up a saucepan - called gameskeeper because the movement is like breaking a rabbits neck - called skier's thumb because the movement is like falling when skiing

Question 248

Which carpal bone is prone to injury

Answer 248

- the scaphoid - it is in direct contact with the radius so putting ur hand out to stop yourself falling will put all the force directly through the scaphoid

Question 249

What is the cutaneous distribution of the median and ulnar nerves in the hand

Answer 249

Median - palmar lateral 3.5 digits and extends over the fingertips to posterior side up to the distal interphalangeal joint Ulnar - palmar medial 1.5 digits and extends over the fingertips to teh posterior side up to the distal interphalangeal joint

Question 250

What are the thenar muscles? | What is their nerve supply

Answer 250

- muscles at the base of the thumb (abductor pollicis brevis, flexor pollicis brevis and opponens pollicis) - the median nerve

Question 251

If infection occurs in the synovial flexor tendon sheath, how far will it spread in the - middle finger - thumb - little finger

Answer 251

Middle finger - to the distal skin crease on the palm of the hand Thumb - into the forearm Little finger - into the forearm

Question 252

Where do the synovial flexor tendon extend to for the Thumb and little finger? Index, middle and ring finger?

Answer 252

Thumb and little finger - into the forearm Index, middle and ring finger - the distal crease on the palm of the hand

Question 253

How do you test the interossei muscles

Answer 253

-test abduction and adduction of the fingers

Question 254

What are the differences in the motor and sensory loss due to injury of the median nerve at the elbow and at the wrist?

Answer 254

- sensory loss will be the same for injury at the elbow and writ - motor loss at the wrist - will paralyse the LLOAF muscles (lateral two lumbricals, opponens pollicis, abductor pollicis brevis and flexor pollicis brevis) - motor at the elbow will paralyse the long flexor to the thumb - both flexors to the index and middle fingers - superficial flexors to the ring and little finger - and LLOAF muscles

Question 255

Where is a common point of origin for the superficial extensor muscles

Answer 255

-the lateral epicondyle of the humerus

Question 256

What are the muscles of the forearm extensor compartment

Answer 256

Superficial compartment - extensor carpi ulnaris - extensor digiti minimi - extensor digitorum (group of 4 tendons in one) - extensor carpi radialis longus - extensor carpi radialis brevis Deep compartment - extensor indicis (pulls on index finger) - extensor pollicis longus (pulls on the thumb) - extensor pollicis brevis (pulls on the thumb, wraps over both the extensor carpi radialis muscles) - abductor pollicis longus (pulls the thumb away from the hand, and wraps over both extensor carpi radialis muscles too) - supinator muscle (wraps around the radius and causes it to twist) - all supplied by the radial nerve - all run under the extensor retinaculum (on the back of the hand)

Question 257

Give the origin, insertion, innervation and function of the extensor carpi ulnaris muscle

Answer 257

Origin = lateral epicondyle of the humerus Insertion = carpal bone just beyond the wrist joint Innervation = Function = extends the wrist -extends beyond the wrist joint

Question 258

Give the origin, insertion, innervation and function of the extensor digiti minimi muscle

Answer 258

Origin = lateral epicondyle of the humerus Insertion = Innervation = Function = extends the little finger

Question 259

Give the origin, insertion, innervation and function of the extensor digitorum muscle

Answer 259

Origin = Insertion = Innervation = Function =

Question 260

Give the origin, insertion, innervation and function of the extensor carpi radialis brevis muscle

Answer 260

Origin = Insertion = Innervation = Function =

Question 261

Give the origin, insertion, innervation and function of the extensor carpi radialis longus muscle

Answer 261

Origin = Insertion = Innervation = Function =

Question 262

Give the origin, insertion, innervation and function of the extensor indicis muscle

Answer 262

Origin = Insertion = Innervation = radial nerve Function = extends index finger

Question 263

Give the origin, insertion, innervation and function of the extensor pollicis longus muscle

Answer 263

Origin = Insertion = Innervation = radial nerve Function = extends the thumb

Question 264

Give the origin, insertion, innervation and function of the extensor pollicis brevis muscle

Answer 264

Origin = Insertion = Innervation = radial nerve Function = extends the thumb

Question 265

Give the origin, insertion, innervation and function of the abductor pollicis longus muscle

Answer 265

Origin = Insertion = Innervation = radial nerve Function = abducts the thumb away from the hand

Question 266

Give the origin, insertion, innervation and function of the suppinator muscle

Answer 266

Origin = Insertion = Innervation = radial nerve Function = causes the radius to twist over the ulna

Question 267

Give the origin, insertion, innervation and function of the brachioradialis muscle

Answer 267

Origin = Insertion = Innervation = Function =

Question 268

Why is it possible to straighten the index finger and the little finger independently while the middle and ring finger tend to extend together

Answer 268

- the index, middle, ring and little finger all have the tendons of the extensor digitorum connected to them and these tendons are joined together - the index finger also has the extensor indicis allowing straightening - the little finger also has the extensor digiti minimi allowing straightening

Question 269

Describe the division and attachment of the extensor digitorum on the dorsum of the hand

Answer 269

- extensor digitorum divides into 3 - the middle part attaches to the proximal phalanx - the two lateral parts attach to the distal phalanx

Question 270

Under which tendons does the radial artery pass to enter the anatomical snuff box

Answer 270

- the abductor pollicis longus | - the extensor pollicis brevis

Question 271

Where does the subclavian artery change its name to the axillary artery-

Answer 271

-outer border of the first rib

Question 272

Where is the 1st, 2nd and 3rd part of the axillary artery

Answer 272

1st - outer border of the 1st rib to the start of pectoralis minor 2nd - behind pectoralis minor 3rd - end of pectoralis minor and the lower border of pectoralis major

Question 273

If the brachial artery was damaged in the antecubital fossa, which vessels would continue blood supply of the forearm

Answer 273

- the ulnar collateral artery | - the radial collateral artery

Question 274

Between which bones does flexion and extension of the elbow occur

Answer 274

-humerus and ulna

Question 275

Which movements occur between the humerus and the ulna

Answer 275

- flexion of the elbow | - extension of the elbow

Question 276

Which movements occur at the elbow joint

Answer 276

- flexion and extension | - pronation and supination

Question 277

Between which bones does pronation and supination occur

Answer 277

-the ulna and radius

Question 278

Which movements occur between the radius and ulna

Answer 278

-pronation and supination

Question 279

In the anatomical position the biceps does what to the elbow joint

Answer 279

-flexion

Question 280

At a 90 degree angle to the elbow, the biceps does what to the elbow joint

Answer 280

-supination

Question 281

What is the point of articulation of the ulna on the humerus

Answer 281

-the trochlear of the humerus

Question 282

What is the point of articulation for the radius on the humerus

Answer 282

-the capitulum

Question 283

How is the pad on the arm deep to the brachialis muscle useful in xrays of the elbow joint

Answer 283

- this fat pad does not absorb xrays as effectively so actually can be seen on an xray - if there if damage to the elbow joint it will widen or come away from the bone

Question 284

Which ligament holds the head of the radius against the ulna

Answer 284

- the annular ligmanent - not actually attached to the radius - lined by synovium and articular cartilage

Question 285

What kind of joint is the wrist joint

Answer 285

- a condyloid joint

Question 286

What kind of joint is between the trapezium and metacarpal of the thumb

Answer 286

-a saddle joint

Question 287

What kind of joint are the metacarpophlangeal joints

Answer 287

-condyloid joints (has a curvature and a lesser curvature)

Question 288

Give two examples of condyloid joints

Answer 288

- metacarpophalangeal joints | - wrist joint between the scaphoid, lunate bone and radius

Question 289

What kind of joints are the interphalangeal joints

Answer 289

-hinge joints

Question 290

What forms the extensor expansion on the posterior aspect of the fingers

Answer 290

-the extensor digitiorum

Question 291

Which structures form the anterior border of the anatomical snuff box

Answer 291

- abductor pollicis longus | - extensor pollicis brevis

Question 292

Which structure form the posterior border of the anatomical snuff box

Answer 292

-extensor pollicis longus tendon

Question 293

Which muscle can be connected to the tendon of the extensor pollicis longus to repair a hammer thumb

Answer 293

-extensor indicis

Question 294

Apart from allowing the index finger to straighten independently, what else is the extensor indicis clinically important for

Answer 294

-the muscle of the extensor indicis can be connected to the tendon of the extensor pollicis longus to repair a hammer thumb

Question 295

What structures border the anatomical snuff box

Answer 295

Medially bound by the extensor pollicus longus Laterally bound by the extensor pollicis brevis and abductor pollicis longus Scaphoid bone forms the floor of the anatomical snuff box

Question 296

What structures lie in the anatomical snuff box

Answer 296

- radial artery | - cephalic vein

Question 297

Where are the interossei and lumbricals inserted to

Answer 297

-the proximal part of the extensor expansion

Question 298

Explain tennis elbow

Answer 298

-this is damage to the lateral epicondyle of the humerus

Question 299

What is golfer's elbow

Answer 299

-this is damage to the medial epicondyle of the humerus

Question 300

What is mallet finger

Answer 300

- this is when the insertion of the an extensor tendon to the distal phalanx ruptures - the distal interphalangeal joint is held in flexion - when examined it can be fully extended manually quite easily -an acute injury version of mallet finger

Question 301

What is swan neck finger

Answer 301

- when the insertion of the extensor tendon on the distal interphalageal joint ruptures - the tip of the finger is held in flexion - the middle slip of the extensor tendon overcompensates - so the proximal interphalangeal joint is held in extension - finger looks like swan neck -this is a chronic injury version of the mallet finger

Question 302

Explain a boutonniere deformity

Answer 302

- if the insertion of an extensor tendon to the proximal interphalangeal joint ruptures - the distal interphalangeal joint (marginal side slips) overcompensate so the distal joint is held in extension - the proximal interphalangeal joint pokes through the gap in the extensor tendon like a button giving the name

Question 303

Muscles that produce pronation

Answer 303

- pronator teres | - pronator quadratus

Question 304

Muscles that produce supination

Answer 304

- supinator | - biceps

Question 305

Is the annular ligament attached to the radius

Answer 305

-no it is wrapped around the head (and neck) of the radius

Question 306

What is the nerve supply of the extensor compartment of the forearm and what are of the skin does this nerve also supply

Answer 306

- radial nerve | - posterior aspect of 3.5 lateral digits up to the distal interphalangeal joint

Question 307

Which bone lies in the base of the anatomical snuff box

Answer 307

-scaphoid

Question 308

Which nerve and vein cross the anatomical snuff box superficially

Answer 308

- radial artery | - cephalic vein

Question 309

If the thoracic 1 nerve root is damaged which group muscles will be paralysed and which area of skin will be anaesthetic

Answer 309

- all the muscles in the hand will be paralysed | - the skin over the medial arm is anaesthetic

Question 310

Which muscle is the most powerful supinator and which position does the elbow need to be in to maximise its force

Answer 310

- biceps | - elbow flexed to a 90 degrees

Question 311

Which fingers have two extensors and tendons

Answer 311

-index finger and little finger

Question 312

Describe how the radius moves during pronation and supination

Answer 312

- the proximal radius rotates on its own axis | - the distal radius rotates round the ulna

Question 313

On the lateral aspect of the knee, which structure can you feel subcutaneously

Answer 313

-the tibial plateau

Question 314

What sits just underneath the skin of the thigh

Answer 314

- the fascia lata | - thinner going posteriorly and anteriorly of the thigh

Question 315

Give the origin, insertion, innervation and function of the sartorius muscle

Answer 315

Origin = anterior superior iliac spine Insertion = tibia Innervation = Function =

Question 316

Give the origin, insertion, innervation and function of the tensor fascia lata muscle

Answer 316

Origin = deep surface of the fascia lata Insertion = Innervation = Function =

Question 317

Name the muscles in the anterior compartment of the thigh

Answer 317

quadriceps - rectus femoralis - vastus lateralis - vastus medialis - vastus intermedius

Question 318

Give the origin, insertion, innervation and function of the quadriceps muscle

Answer 318

``` 5 origins Origin of straight head of rectus femoris = on the hip joint on the lip of the acetabulum Origin of reflected head of rectus femoris = Origin of vastus lateralis = femur Origin of vastus medialis = femur Origin of vastus intermedius = femur Insertion = Innervation = Function = ```

Question 319

Give the origin, insertion, innervation and function of the rectus femoris muscle

Answer 319

Origin = lip of the acetabulum Origin = lateral to the lip of the acetabulum Insertion = Innervation = Function = flex the hip and straighten the knee Runs straight down the thigh

Question 320

What type of muscle is the rectus femoris

Answer 320

-bipennate muscle

Question 321

Give the origin, insertion, innervation and function of the vastus lateralis muscle

Answer 321

Origin = femur Insertion = Innervation = Function = extend the knee

Question 322

Give the origin, insertion, innervation and function of the vastus medialis muscle

Answer 322

Origin = femur Insertion = Innervation = Function = extend the knee

Question 323

Give the origin, insertion, innervation and function of the vastus intermedius muscle

Answer 323

Origin = femur Insertion = Innervation = Function = extend the knee

Question 324

Which direction is knee bent

Answer 324

-inwards (a valgus direction)

Question 325

Are the hip, knee and ankle all on a straight line, which other structure is on this line

Answer 325

Yes | -the tibia

Question 326

In which direction is the patella most likely to dislocate during strong contraction of the quadriceps

Answer 326

-laterally

Question 327

Which two mechanisms counteract the lateral dislocation of the patella

Answer 327

- the inferior fibres of the vastus medialis muscles (they are horizontal to patella and pull it medially) (active) - the lateral part of the groove on the femur is much more prominent than the medial part so greater mechanical resistance to patella moving laterally (passive)

Question 328

Give an example of an active mechanism use to counteract the lateral dislocation of the patella

Answer 328

-the inferior fibres of the vastus medialis muscles (they are horizontal to patella and pull it medially)

Question 329

Give an example of a passive mechanism used to counteract the lateral dislocation of the patella

Answer 329

-the lateral part of the groove on the femur is much more prominent than the medial part so greater mechanical resistance to patella moving laterally

Question 330

Where does the long sapheanous vein run

Answer 330

- medial aspect of the thigh | - posterior to the sartorious muscle

Question 331

Name the muscles on the medial aspect of the thigh

Answer 331

Adductor muscles - adductor longus - adductor brevis - adductor magnus - adductor gracilis

Question 332

What structures border the femoral triangle

Answer 332

- the inguinal ligament - sartorious - adductor longus - the floor of the femoral triangle is the pectoneus muscle - lateral part of the floor of the triangle are iliopsoas muscle from the iliacus muscle

Question 333

What vein does the long saphenous vein join

Answer 333

-the common femoral vein

Question 334

What structures lie in the femoral triangle

Answer 334

- common femoral vein - common femoral artery - femoral nerve - lymphatics

Question 335

Where is the saphenofemoral junction

Answer 335

-where the long spahenous vein join the common femoral vein

Question 336

Where does the neurovascular bundle of the femoral triangle lead to

Answer 336

- travels along sartorious | - as far as the adductor canal and through the adductor hiatus into the popliteal fossa

Question 337

Which muscle divides the anterior and medial compartment of the thigh

Answer 337

-the sartorius muscle

Question 338

Give the origin, insertion, innervation and function of the adductor magnus muscle

Answer 338

Origin = pubis bone Origin = ischial tuberosity Insertion of pubic component = shaft of the femur Insertion of hamstring component = adductor tubercle on the medial condyle of the femur Innervation = Function =

Question 339

Give the origin, insertion, innervation and function of the adductor gracilis muscle

Answer 339

Origin = pubis bone Insertion = tibia Innervation = Function =

Question 340

Give the origin, insertion, innervation and function of the adductor brevis muscle

Answer 340

Origin = pubis bone Insertion = femur Innervation = Function =

Question 341

Give the origin, insertion, innervation and function of the adductor longus muscle

Answer 341

Origin = pubis bone Insertion = femur Innervation = Function =

Question 342

Which nerve can be found between adductor longus and adductor brevis

Answer 342

-obturator nerve

Question 343

What creates the adductor hiatus

Answer 343

-the v space between the two insertion points of the adductor magnus muscle

Question 344

Which superficial vein is a primary site for varicose veins?

Answer 344

- long saphenous vein | - it can be used in cardiac and limb bypass surgery

Question 345

Give the origin, insertion, innervation and function of the ilio-psoas muscle

Answer 345

Origin = Insertion = lesser trochanter of the femur Innervation = Function=

Question 346

What is the ligamentum patellae and where does it attach

Answer 346

- also called the patella ligament - lies on top of the patella - attached to the tibial tuberosity

Question 347

What is femoral hernia

Answer 347

- where bowel passes in the space between the inguinal ligament and superior pubic ramus - this is where the femoral vessels and nerve pass from the back of the abdomen into the thigh

Question 348

How and where is a femoral blood sample taken from

Answer 348

- in front of the hip - where the external iliac artery becomes the femoral artery - a needle can be passed into the femoral artery to take an arterial sample - a needle can be passed medial to the femoral artery to obtain a sample from the femoral vein

Question 349

What can cause paralysis of the quadriceps

Answer 349

- damage or disease of the femoral nerve | - the femoral nerve supplies all the muscles in the anterior compartment of the thigh

Question 350

What is the surface marking of the femoral artery and saphenous opening

Answer 350

Femoral artery - (within 1.5cm of) the point halfway between the pubic tubercle and the anterior superior iliac spine Saphenous opening - 3cm below and lateral to the pubic tubercle, medial to the femoral artery (which is 3cm below the inguinal cancal)

Question 351

What is the order of the femoral artery, vein and nerve in the groin

Answer 351

Lateral to medial Nerve, artery and vein

Question 352

Which vein becomes the superficial femoral vein? Going up the leg

Answer 352

The popliteal vein as it passes through the adductor canal

Question 353

What is supplied by the femoral nerve? Motor and sensory

Answer 353

Motor - anterior compartment of the thigh | Sensory -anterior thigh skin, hip and knee joint

Question 354

What are the attachments of the adductor muscles

Answer 354

- all take origin from the pubis bone | - all insert into the femur

Question 355

Which nerve supplies the adductor muscles

Answer 355

-obturator nerve

Question 356

What passes through the adductor canal

Answer 356

- superficial femoral artery | - popliteal vein

Question 357

The muscles of the thigh, leg, arm and forearm are contained within a facsia so the fat is not directly on the muscles, which musces are not contained in a fascia

Answer 357

- pectoralis | - gluteus region

Question 358

Name the muscles on the posterior aspect of the thigh

Answer 358

Hamstring muscles -all originate on the ischial tuberosity

Question 359

Give the origin, insertion, innervation and function of the gluteus medius muscle

Answer 359

Origin = posterior 2/3 of the outer wing of the ilium Insertion = greater trochanter of the femur Innervation = Function =

Question 360

Give the origin, insertion, innervation and function of the quadratus femoris muscle

Answer 360

Origin = Insertion = Innervation = Function =

Question 361

Which tendon runs in between the gemellus superior and gemellus inferior muscle

Answer 361

-the tendon of the obturator internus muscle

Question 362

Give the origin, insertion, innervation and function of the gemellus superior muscle

Answer 362

Origin = Insertion = Innervation = Function =

Question 363

Give the origin, insertion, innervation and function of the gemellus inferior muscle

Answer 363

Origin = Insertion = Innervation = Function =

Question 364

Give the origin, insertion, innervation and function of the gluteus minimus muscle

Answer 364

Origin = Insertion = greater trochanter of the femur Innervation = Function = abduction of the hip joint (pull femur outwards and greater trochanter upwards) needed for walking

Question 365

Where would be advised to do an intramuscular injection in the buttocks

Answer 365

- the upper outer quadrant of the buttocks | - if injected in the lower medial, there is risk of the sciatic nerve damage

Question 366

Describe the spread of the hamstring around the popliteal fossa

Answer 366

-1 muscle passes laterally to it biceps femoris -3 muscles pass medially to it semi membranosus, semi tendonosus

Question 367

Where does the sciatic nerve supply

Answer 367

-posterior compartment of the thigh

Question 368

Give the origin, insertion, innervation and function of the biceps femoris muscle

Answer 368

Origin = ischial tuberosity Insertion = head of the fibula Innervation = Function = long head will extend the hip and flex the knee, the short head will only flex the knee

Question 369

Give the origin, insertion, innervation and function of the semi tendinosus muscle

Answer 369

Origin = ischial tuberosity Insertion = Innervation = sciaitic nerve Function = extend the hip, flex the knee (as cross the hip joint)

Question 370

Give the origin, insertion, innervation and function of the semi membranosus muscle

Answer 370

Origin = Insertion = Innervation = Function = flex the knee, extends the hip (as cross the hip)

Question 371

What does the sciatic nerve split into

Answer 371

- the tibial nerve runs between the two heads of gastronemius to enter the posterior calf - the common peroneal nerve (also called the common fibula nerve) runs laterally round the head of the fibula

Question 372

Which structures form the popliteal fossa

Answer 372

Above laterally - biceps femoris Above medially - semimembranosus muscle and semitendonosus muscle Below medially - medial head of the gastronemius muscle Below laterally - lateral head of the gastronemius muscle Floor -plantaris muscle

Question 373

What structures are present in the popliteal fossa

Answer 373

-the sciatic nerve dividing into the tibial nerve (running in between the two heads of gastronemius) and the common peroneal nerve (running laterally round the head of the fibula) - popliteal artery - popliteal vein

Question 374

How many compartments does the leg have

Answer 374

3 Lateral, posterior and anterior - each is supplied by a single nerve and a single artery so - popliteal artery divides into anterior, posterior and peroneal artery - common peroneal divides into deep peroneal and superficial peroneal nerve Anterior - anterior tibial artery (supplies anterior) - deep peroneal nerve Posterior - posterior tibial artery (supplies posterior and the foot) - tibial nerve Lateral - peroneal artery (supplies lateral) - Superficial peroneal nerve

Question 375

Where does the short saphenous vein travel

Answer 375

- runs up the posterior aspect of the calf | - pierces the fascia and enters the popliteal vein in the popliteal fossa

Question 376

Which nerve runs alongside the short saphenous vein and what does it supply

Answer 376

- the sural nerve | - it supplies sensation to the back of the calf and part of the foot

Question 377

Which nerve does the sural nerve branch off

Answer 377

-the tibial nerve

Question 378

Which bone do we sit on

Answer 378

- the ischium | - the ischial tuberosity

Question 379

Give the origin, insertion, innervation and function of the plantaris muscle

Answer 379

Origin = femure Insertion = calcanium Innervation = Function = Has tendon that runs on the deep surface of the gastrocnemius till the calcanium

Question 380

What is sciatica and give the common anatomical cause

Answer 380

- compression of the sciatic nerve in the intervertebral foramina - causing pain in the skin of the lateral thigh and leg into the foot - prolapse of the intervertebral disc between L5 and S1 is a common cause - the sciatic nerve arises from the L5 to S4

Question 381

Explain a popliteal aneurysm

Answer 381

- the popliteal artery wall can be disease and the pressure of the blood can cause swelling (an aneurysm) - high risk of clot within aneurysm or a rupture

Question 382

What does the trendelenburg test do

Answer 382

- tests the gluteaus medius and minimus muscles - during normal walking, when one leg is lifted off the ground, the opposite gluteus medius and minimus contract to support the pelvis in a horizontal position - if contraction of the gluteus medius and minimus is insufficient then the pelvis will tilts so walking is difficult and looks abnormal -the gluteus medius and minimus abduct the hip joint

Question 383

What do the gluteus medius and minimus do

Answer 383

-abduct the hip joint

Question 384

What is the function of the hip extensors and which is the most powerful

Answer 384

- gluteus maximus | - used for climbing up hill and up stairs

Question 385

Which muscles abduct the hip and when is abduction vital to normal function

Answer 385

- gluteus minimus and medius | - they hold the pelvis horizontal during walking when one leg is off the ground

Question 386

What structures pass through the greater sciatic foramen

Answer 386

- sciatic nerve - piriformis muscle - superior and inferior gluteal vessels - pudendal nerves (to perineum)

Question 387

Is the ischial spine palpable in the living, if so how do you palpate it

Answer 387

-yes through the vagina or rectum

Question 388

Where is the surface marking of the sciatic nerve and why is this important

Answer 388

- lower inner quadrant of the buttock | - drug injection into the buttock is common so need to be aware to avoid the nerve

Question 389

If the sciatic nerve is completely cut which parts of the lower limb will still have a nerve supply

Answer 389

- sensation from the anterior and medial thigh (femoral and obturator nerves) - sensation from the medial dorsum of the foot up the anteromedial calf (saphenous nerve, branch of femoral) - motor to the anterior and medial compartments of the thigh

Question 390

Which major vessels supply the buttock with blood

Answer 390

- the superior and inferior gluteal arteries | - both branches of the posterior internal iliac artery

Question 391

What is the leg

Answer 391

-from the knee joint to the ankle joint

Question 392

Name the muscles of the anterior compartment of the leg and the dorsum of the foot

Answer 392

Superficial compartment - tibialis anterior - extensor digitorum longus - peroneus tertius Deep compartment - extensor hallucis longus - extensor hallucis brevis - extensor digitorum brevis

Question 393

Which artery and nerve supplies the anterior compartment of the leg

Answer 393

- anterior tibial artery | - deep peroneal nerve

Question 394

Which artery and nerve supplies the posterior compartment of the leg

Answer 394

- posterior tibial artery | - tibial nerve

Question 395

Which artery and nerve supplies the lateral compartment of the leg

Answer 395

- peroneal artery | - superficial peroneal nerve

Question 396

What is the name of the fascia on the anterior aspect of the ankle

Answer 396

-the extensor retinaculum

Question 397

What is the name of the fascia covering the anterior compartment of the leg

Answer 397

- deep fascia of the leg | - attaches to tibia medially and fibula laterally and completely surrounds the anterior compartment of the foot

Question 398

Name the muscles in the lateral compartment of the leg and foot

Answer 398

Superficial compartment -peroneus longus (also called fibularis longus) Deep compartment -peroneus brevis (also called fibularis brevis)

Question 399

Give the origin, insertion, innervation and function of the peroneus longus (fibularis longus) muscle

Answer 399

Origin = Insertion = base of the first metatarsal (big toe) Innervation = superficial branch of the peroneal nerve Function = flex the ankle joint (plantar flexion) causing toes to be pointed, pulls medial side of the foot more (dorsiflexion)

Question 400

Give the origin, insertion, innervation and function of the peroneus brevis (fibularis brevis) muscle

Answer 400

Origin = Insertion = base of the fifth metatarsus Innervation = superficial branch of the peroneal nerve Function = flex the ankle joint (plantar flexion) causing toes to be pointed, pulls lateral side of the foot more

Question 401

What does the superficial branch of the peroneal nerve do

Answer 401

- motor to the peroneus longus (fibularis longus) and peroneus brevis (fibularis brevis) muscles - sensation to the lateral aspect of the foot

Question 402

Which nerve runs deep to the peroneus longus muscle

Answer 402

-the common peroneal nerve (common fibulla nerve)

Question 403

Why is the common peroneal nerve (common fibula nerve) at risk

Answer 403

- runs behind the fibula | - so can be damaged by direct pressure or if the fibula becomes broken

Question 404

Which nerve is at risk if the head or neck of the fibula is broken

Answer 404

-the common peroneal nerve (common fibula nerve)

Question 405

What is the foot drop and indicator of and why

Answer 405

- damage to the common peroneal nerve - the common peroneal nerve supplies all the muscles lift the foot up and lift the toes up - this is a problem for walking because we need to lift the foot up to swing the leg over when we take the next step - the patient will need to lift the knee higher to top the toes hitting the floor causing an abnormal gait (pattern of walking)

Question 406

Which nerve supplies all the muscles of the anterior compartment of the leg

Answer 406

-the deep peroneal nerve

Question 407

What forms the medial malleolus

Answer 407

-the lower end of the tibia

Question 408

What forms the lateral malleolus

Answer 408

-the lower end of the fibula

Question 409

Give the origin, insertion, innervation and function of the tibialis anterior muscle

Answer 409

Origin = Insertion = base of the first metatarsus (big toe) Innervation = Function =

Question 410

Give the origin, insertion, innervation and function of the extensor hallucis longus muscle

Answer 410

Origin = Insertion = base of the first metatarsus (big toe) Innervation = Function = extend the big toe

Question 411

Give the origin, insertion, innervation and function of the extensor digitorum longus muscle

Answer 411

Origin = Insertion = to the base of the lateral four metatarsus Innervation = Function = extend the digits

Question 412

Give the origin, insertion, innervation and function of the peroneus tertius muscle

Answer 412

Origin = Insertion = base of fifth metatarsus (little toe) Innervation = Function = extend the digits

Question 413

Give the origin, insertion, innervation and function of the extensor digitorum brevis muscle

Answer 413

Origin = Insertion = Innervation = Function =

Question 414

Give the origin, insertion, innervation and function of the extensor hallucis brevis muscle

Answer 414

Origin = Insertion = Innervation = deep peroneal nerve Function =

Question 415

Which artery on the dorsal aspect of the foot is a continuation of the anterior tibial artery

Answer 415

- dorsalis pedis pulse | - it goes between the 1st and 2nd metatarsus to enter the sole of the foot

Question 416

Through which membrane does the anterior tibial artery pass to enter the anterior compartment of the leg

Answer 416

-through the interosseus membrane between the fibula and tibia

Question 417

Which branch of the popliteal artery finished before it gets to the ankle

Answer 417

-the peroneal artery

Question 418

Why does a fractured tibia have difficulty healing

Answer 418

- the lower 1/3 of the tibia has no muscle attachements so has difficulty healing - bone receive blood supply from the muscle attached to them - tibia is quite superficial so a fracture could pierce the skin and allw introduction of infection - bone infection is difficult to treat because antibiotics do not penetrate mineral bone effectively

Question 419

Where would ankle pulse be felt

Answer 419

- the dorsal pedis pulse between the first and second metatarsus on the dorsal aspect of the foot - the posterior tibial pulse can be felt behind the medial malleous

Question 420

What is a bursa

Answer 420

- a pocket of synovium which produces synovial fluid | - they allow tissue to slide around freely

Question 421

Explain the clergyman' syndrome

Answer 421

- this is when the bursa over the infra-patella tendon become damaged and inflammed - the bursa swells restricting bending of the knee and makes kneeling painful - clerygymen kneel regularly giving it the name

Question 422

Explain compartment syndrome in relation to the lower limb

Answer 422

- a compartment is completely enclosed by strong fascia - damage to structures within the compartment will lead to swelling - swelling increases the pressure in the compartment until it exceeds the capillary perfusion pressure - this stops blood flow and the compartment dies - can be treated by cutting open the fascia to relieve pressure

Question 423

Which nerve supplies the anterior and lateral compartments of the leg

Answer 423

Anterior compartment - deep branch of the common peroneal nerve (deep peroneal nerve) Lateral compartment - superficia branch of the common peroneal nerve (superficial peroneal nerve)

Question 424

Where is the deep peroneal nerve and superficial peroneal nerve at risk of damage

Answer 424

-where they run against the neck of the fibula just under the skin

Question 425

Which artery supplies the anterior compartment of the leg

Answer 425

-anterior tibial artery

Question 426

How many extensor tendons are there to each of the toes | Where do they originate?

Answer 426

Two tendons to each of the toes Big toe - extensor hallucis longus and extensor hallucis brevis 2nd to little toe - extensor digitorum longus and extensor digitorum brevis - the longus tendon is attached to the fibula and interosseus membrane - the brevis tendon is attached to the dorsum calcanium and surrounding ligaments in the lateral foot

Question 427

Where are the palpable pulses in the leg

Answer 427

- behind the knee in the popliteal fossa (between the heads of gastrocnemius muscles) - the posterior tibial pulse (posterior to the medial malleolus) - the dorsalis pedis (between the extensor tendons of the hallux and the second toe)

Question 428

What do the nutrient arteries in bone do?

Answer 428

-they supply the bone marrow

Question 429

Describe the movements at the ankle joint

Answer 429

- dorsiflexion - plantar flexion -the ankle joint is between the tibia and fibula mortice and the talus

Question 430

Name the muscles of the posterior compartment of the leg

Answer 430

Superficial compartment - gastrocnemius - soleus Deep compartment (flexors for the toes) - flexor hallucis longus - flexor digitorum longus - tibialis posterior

Question 430

Give the origin, insertion, innervation and function of the gastrocnemius muscle

Answer 430

Origin of lateral head = Origin of medial head = above the condyles of the femur Insertion = superficial aspect of the achilles tendon Innervation = Function = flex the knee and plantar flex the ankle

Question 431

Why is the tendon of the plantaris muscle important

Answer 431

-the tendon can be removed and used as a graft for repairing other tissues such as cut tendons and ligaments

Question 432

Give the origin, insertion, innervation and function of the soleus muscle

Answer 432

Origin = fibula Insertion = calcanius Innervation = Function = flexing the ankle

Question 433

Give the origin, insertion, innervation and function of the popliteus muscle

Answer 433

Origin = Insertion = Innervation = Function =

Question 434

Give the origin, insertion, innervation and function of the flexor hallucis longus muscle

Answer 434

Origin = Insertion = 1st metatarsus (big toe) Innervation = Function = flex the big toe -has a tendon that goes behind the medial malleolus to the big toe

Question 435

Give the origin, insertion, innervation and function of the flexor digitorum longus muscle

Answer 435

Origin = Insertion = Innervation = Function = flex the toes

Question 436

Give the origin, insertion, innervation and function of the tibialis posterior muscle

Answer 436

Origin = Insertion = base of the 5th metatarsus (little toe) Innervation = Function = flex the ankle and invert the foot

Question 437

What is the rhyme Tom, Dick and very naughty Harry used to remember

Answer 437

``` Tom = tibialis posterior muscle Dick = flexor digitorum longus And = artery Very = vein Naughty = posterior tibial Nerve Harry = flexore hallucis longus ```

Question 438

Describe the 4 layers of the sole of the foot

Answer 438

Fascia from the calcanium to the base of the toes Superficial muscles (1) - abductor hallucis brevis (move big toe out) - abductor digiti minimi (move little toe out) - flexor digitorum brevis (flex the 4 lateral toes) Deep muscles (2) - flexor hallucis longus (flex big toe) - flexor digitorum longus (flex other toes) - lumbricles (attached to the flexor longus tendons and travel to the dorsal aspect of the toe to attach to the extensor tendons) - quadratus plantae Deeper muscles (3) - flexor hallucis brevis (flex big toe) - adductor hallucis (move big toe in) - adductor digiti minimi (move little toe) - flexor digiti minimi brevis (flexes the metatarsophalangeal joint of the little toe) Deepest muscles (4) -interossei muscles (plantar and dorsal) -interossei muscles (similar to the hand but the center digit for the foot is the 2nd toe instead of the middle finger in the hand) the dorsal interossei (top of the foot) -move the second toe side to side -moves other toes away from the 2nd toe the plantar interossei (sole of the foot) -moves the other toes towards the 2nd toe

Question 439

Which structure holds up the arch of the foot

Answer 439

-the fascia running from the calcanium to the base of the toes

Question 440

Name the bones of the foot

Answer 440

- calcanium - talus - cuboid - naviculum (navicular) - medial cuniforms - intermediate cuniforms - lateral cuniforms

Question 441

Another name of the achilles tendon

Answer 441

-tendo-calcaneus (calcaneal tendon)

Question 442

What can cause an achilles tendon rupture?

Answer 442

- playing sport which requires rapid change of direction like squash - healing is prolonged

Question 443

How can long distance travel lead to deep vein thrombosis

Answer 443

- dehydration can lead to altered blood constituents - prolonged inactivity reduces flow of blood - pressure on calves can alter the endothelium of the blood vessels - all these can lead to a deep vein thrombosis - if the clot breaks free and travels to the right ventricle - it can cause cardiac arrest and death

Question 444

What would be the effect of damage to the common peroneal (fibular) nerve

Answer 444

- paralysis of the muscles in the anterior and lateral compartments - loss of sensation down the lateral leg from the knee to the ankle and onto the dorsum of the foot including the dorsum of the medial four toes

Question 445

Which muscles are attached to the achilles tendon

Answer 445

- gastrocnemius - soleus - plantaris

Question 446

What is the nerve supply of the posterior compartment

Answer 446

-tibial nerve (branch of the sciatic nerve)

Question 447

Where does the long saphenous vein start and what is its route up the limb

Answer 447

- starts on the medial end of the dorsal venous arch on the dorsum of the foot - runs up anterior to the medial malleolus, just lateral to the tibialis anterior tendon - runs up the anteromedial calf and pass posteriorly to lie over the sartorius muscle - into the upper thigh to the apex of the femoral triangle - joins the femoral vein 3cm below the inguinal ligament

Question 448

What is the action of the peroneal muscles

Answer 448

- peroneal longus = ankle flexion and eversion at the subtalar joint - peroneal brevis = ankle flexion and eversion at the subtalar joint - tertius =ankle dorsiflexion (extension) and eversion at the subtalar joint

Question 449

How many flexor tendons does each toe have and what are their origins

Answer 449

Big toe - one =flexor hallucis Other toes -2 = flexor digitorum longus, flexor digitorum brevis Longus is attached to the tibia Brevis is attached to the calcaneum

Question 450

What is the importance of the deep veins and their valves

Answer 450

- the deep veins transmit blood back to the heart and work using muscle pumps - the valves only allow blood up the vein and from outside of the leg to the inside - when a muscle is relaxed, the deep veins fill - when the muscle contracts the blood is pumped further up the vein

Question 451

What are the 3 ligaments that attach the pelvis to the femur and state from which pelvic bone they come from

Answer 451

- ilio-femoral (ilium) - pubo-femoral (pubis) - ischio-femoral (ischium)

Question 452

Which two ligaments restrict extension of the hip

Answer 452

- ilio-femoral ligament | - pubo-femoral ligament

Question 453

Femoral dislocation is more common posteriorly than anteriorly because

Answer 453

-there is a weakness in the hip joint as the ischio-femoral ligament does not restrict flexion of the hip

Question 454

What structure travels in the gap in the acetabulum rim

Answer 454

-the nutrient artery feeding the femoral head in children before its fusion to the femoral neck during skeletal maturation

Question 455

What feature of the acetabulum socket helps to resist dislocation of the femur

Answer 455

-fibrocartilagenous labrum over the hemisphere of the head of the femur

Question 456

What is the risk if the neck of the femur is broken

Answer 456

- the blood supply to the mature head of the femur is through the arteries running in the periosteum of the neck of the femur - so if the neck of the femur is broken, the blood supply is interrupted and the head of the femur will undergo necrosis - so might need to be replaced

Question 457

What are the four ligaments that hold the knee in place, how and where are they?

Answer 457

- medial collateral ligament (can also be called the tibial collateral ligament) which stops the tibia moving laterally from a straight position (runs from the medial epicondyle of the femur to the tibia) - lateral collateral ligament (can also be called the fibula collacteral ligament) which stops the tibia moving medially from a straight position (runs from lateral epicondyle of the femur to the fibula) - anterior cruciate ligament which stops the tibia moving forwards relative to the femur (runs from the front of the tibia to the posterior of the femur) - posterior cruciate ligament stops the tibia moving backwards relative to the femur (runs from the posterior of the tibia to the front of the femur)

Question 458

With the knee flexed at 90 degrees, all 4 of the knee ligaments are lax so the tibia can move. As the leg is brought back up in extension of the knee, at about 30 degrees which ligament is tight and at risk of rupture?

Answer 458

- the anterior cruciate ligament is tight - while all the other 3 ligaments are still lax - so it is at risk of rupture if a twisting force was introduced to the joint -at full extension, all the knee ligaments are tight so all can share any force so less risk of damage

Question 459

Which muscle is used to unlock the knee before flexion

Answer 459

- the popliteus muscle | - on the posterior aspect of the knee

Question 460

What shape is the medial and lateral menisci

Answer 460

The medial is a C shape | The lateral is an O shape

Question 461

Why is a medial meniscus tear more common than a lateral meniscus tear

Answer 461

- the lateral meniscus can move with the femur when the knee twists because it is attached at two ends - the medial meniscus cannot move because it is attached to the capsule all the way around its perimeter so it tears

Question 462

Which ligament is attached to the talus and calcanium in a D shape

Answer 462

- the deltoid ligament of the ankle | - on the medial side of the ankle

Question 463

Which ligament travels from the fibula to the talus and from the fibula to the calcanium

Answer 463

- the anterior talo-fibula ligament - the posterior talo-fibula ligament - the fibulo-calcaneal ligament

Question 464

Name the ligaments of the ankle

Answer 464

- the deltoid ligament (on the medial side) - the anterior talo-fibula ligament - the posterior talo-fibula ligament - the fibulo-calcaneal ligament (calcaneofibular ligament)

Question 465

What is osteoporosis

Answer 465

- a common condition in the elderly especially elderly women - causes brittle bones - elderly people who fall and land on their hips often fracture the neck of their femur which then needs to be surgically removed and replaced

Question 466

Which structures connect the tibia and fibula bones

Answer 466

- superior tibiofibular joint - inferior tibiofibular joint - interosseus membrane

Question 467

Which ligaments are commonly damaged in a sprained ankle

Answer 467

- the deltoid ligament (on the medial side) - the anterior talo-fibula ligament - the posterior talo-fibula ligament - the fibulo-calcaneal ligament (calcaneofibular ligament)

Question 468

What does the long plantar ligament on the sole of the foot do

Answer 468

-converts the groove on the cuboid bone into a tunnel which the tendon of the peroneus longus lies

Question 469

What does the plantar calcaneonavicular ligament (also called spring ligament) do

Answer 469

- extends from the sustentaculum tali to the navicular bone - its upper surface forms part of the capsule of the subtalar joint - the head of the talus rests on the spring ligament

Question 470

What structures does the interosseus talocalcaneal ligament attach

Answer 470

-the talus bone to the calcanium bone on the posterior aspect

Question 471

Which movements of the foot allow one to walk on uneven ground

Answer 471

- inversion and eversion | - they take place at the subtalar joint

Question 472

When the lateral border of the foot is slightly raised making the sole of the foot face laterally, the foot is

Answer 472

Eversed -in eversion - the midtarsal joint abducts - when the foot is flat on the ground, there is medial rotation of the leg

Question 473

When the medial border of the foot is slightly raised making the sole of the foot face medially, the foot is

Answer 473

Inversed -inversion - the midtarsal joint adducts - when the foot is flat on the groun, there is lateral rotation of the leg

Question 474

Which muscles invert the foot

Answer 474

- tibialis anterior | - tibialis posterior

Question 475

Which muscles evert the foot

Answer 475

- peroneus longus | - peroneus brevis

Question 476

At which joints does flexion, extension, inversion and eversion of the 'ankle' take place

Answer 476

- flexion and extension occur at the ankle joint (between the tibia, fibula and talus bone) - eversion and inversion occur at the subtalar joint (between the talus and calcanium)

Question 477

Which anatomical features maintain the arches of the foot

Answer 477

- shape of the bones (wedge shaped) - tendons coming from the leg pulling the arch upwards - strong ligaments running between the bones on the plantar surface - the plantar fascia/ligament hold the front and back of the foot close together

Question 478

Which nerves supply the hip joint

Answer 478

- the rule for nerve supply to a joint - the nerve supplying the joint with sensation is the same as the nerve supplying the muscles that move the joint So - femoral (e.g rectus femoris) - obturator (e.g adductors) - tibial component of the sciatic (hamstrings)

Question 479

What are the functions of the cruciate ligaments and how would you test them

Answer 479

anterior cruciate ligament - stops the tibia moving forwards relative to the femur - tested by the Lachman test - put knee at 20-30 degrees of flexion (so ligament is tight) and try pulling the tibia forwards - the tibia should not move Posterior cruciate ligament - stops the tibia moving backwards relative to the femur - placing the knee at a 90 degree flexion and pushing the tibia backwards - there should be a little movement

Question 480

What is the normal angle between the femur and tibia

Answer 480

-about 175 degrees