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MRCS Part B > Anatomy - Lower Limb > Flashcards

Anatomy - Lower Limb Flashcards

1
Q

What is the Garden Classification of Hip fractures?

A

Classification for intracapsular hip fractures

1 - undisplaced and incomplete
2 - undisplaced and complete
3 - slightly displaced and complete
4 - fully displaced and complete

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2
Q

Describe the anatomy of the hip capsule

A

Originates from the rim of the acetabulum proximally

Anteriorly attaches to the intertrochanteric line

Posteriorly attaches 1cm above the intertrochanteric crest

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3
Q

What are the 3 ligaments of the hip joint?

A

Iliofemoral (strongest)
Pubofemoral
Ischiofemoral

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4
Q

Blood supply to the femoral head

A

Retinacular branches of the extracapsular arterial anastamosis formed from the medial and lateral circumflex femoral arteries, retrograde supply from the profunda femoris artery (also small contributions from superior and inferior gluteal arteries)

Minor supply via artery of ligamentum teres (from obturator artery) - negligible in adults

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5
Q

Which muscles attach on to the lesser trochanter?

A

Iliacus and Psoas Major

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6
Q

Action: Psoas Major

A

Flex and externally rotate the hip

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7
Q

Origin: Psoas Major

A

Deep - transverse processes of L1-4
Superficial - lateral surface of T12-L4

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8
Q

Which muscles attach to the iliotibial tract?

A

Gluteus maximus
Tensor fascia lata

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9
Q

Where does gluteus maximus insert?

A

Iliotibial tract and gluteal tuberosity of the femur

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10
Q

Nerve: Gluteus maximus

A

Inferior gluteal nerve (L5-S1)

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11
Q

Action: Gluteus maximus

A

Extension and external rotation of the hip

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12
Q

Nerve: Tensor fascia lata

A

Superior gluteal nerve

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13
Q

Insertion: Gluteus medius and minimus

A

Lateral surface of the greater trochanter

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14
Q

Action: Gluteus medius

A

Abduction during standing
Stabilises the pelvis during walking

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15
Q

Trendelenburg’s gait is associated with which nerve dysfunction?

A

Superior gluteal nerve (passes 5cm superior to the greater trochanter)

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16
Q

Pathway of the sciatic nerve in the pelvis

A

Exits via the greater sciatic foramen emerging below the piriformis muscle

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17
Q

What structures stabilise the knee?

A

AP - ACL + PCL (stronger)
Lateral - LCL + MCL

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18
Q

Which collateral knee ligament is more prone to injury?

A

Medial collateral ligament as it is closely related to the medial meniscus and joint capsule

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19
Q

What is the ‘terribe triad’ of knee injuries?

A

ACL + Medial Meniscus + MCL

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20
Q

Where does the ACL attach?

A

Arises on the lateral wall of the intercondylar notch

Inserts between the tibial spines

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21
Q

How do you avoid DVT in patients undergoing TKR?

A
  • TEDs/Flowtrons
  • LMWH
  • Early mobilisation
  • Hydration
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22
Q

What neurovascular structures are at risk in an anteromedial approach to the knee?

A

Saphenous Nerve
Great Saphenous Vein
Geniculate Arteries

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23
Q

Blood supply to the knee

A

Genicular anastamosis formed from the femoral, popliteal and crural arteries

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24
Q

Nerve supply: Quadriceps

A

L2,3,4 Femoral Nerve

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25
How do you differentiate semimembranosus and semitendinosus?
Both originate from the ischial tuberosity Semimembranosus is more medial and has a membrane-like insertion Semitendinosus is distinguishable by its large tendon insertion
26
Contents of the popliteal fossa (superficial to deep)
Common fibular and tibial nerves Popliteal vein Short Saphenous vein Popliteal artery
27
What are the boundaries of the popliteal fossa?
Superomedial – semimembranosus Superolateral – biceps femoris Inferomedial – medial head of gastrocnemius Inferolateral – lateral head of gastrocnemius and plantaris
28
What area is drained by the popliteal lymph nodes?
Area drained by the short saphenous vein
29
Which muscles form 'pes anserinus'? (Anterior to Posterior)
Sartorius, gracilis and semi tendinosis "Say Grace before Tea "
30
What is the ankle joint?
Synovial joint of the lower limb, between the tibia, fibula and talus bones
31
What joint is responsible for inversion and eversion of the foot?
Subtalar joint (between talus and calcaneum)
32
Which ligamentous structures support the ankle joint?
Medially - deltoid ligament (between the medial malleolus of the tibia and the talus, calcaenum and navicular) Laterally - anterior and posterior talofibular ligaments, calcaneofibular ligament
33
What are the 4 parts of the tibio-fibular syndesmosis?
anterior and posterior inferior talofibular ligaments interosseous ligament inferior transverse ligament
34
Sensation: lateral border of the foot
Sural nerve
35
Sensation: medial border of the foot
Saphenous nervePo
36
Sensation: posterior aspect of the foot/sole
Tibial nerve
37
Sensation: dorsum of the foot (except the first web space)
Superficial peroneal nerve
38
Sensation: first web-space of the dorsum of the foot
Deep peroneal nerve
39
Pulse: posterior tibial
2-3cm distal & posterior to the tip of the medial malleolus
40
Pulse: dorsalis pedis
just lateral to EHL tendon proximally
41
What is dorsalis pedis artery a continuation of?
Anterior tibial artery
42
What structures run posterior to the medial malleolus? (anterior to posterior)
Tibialis anterior tendon Flexor digitorum longus tendon Posterior tibial artery Posterior tibial vein Tibial nerve Flexor hallucis longus tendon Remember: Tom, Dick And Very Naughty Harry
43
Muscles of the superficial posterior compartment of the leg
Gastrocnemius Soleus Plantaris
44
Muscles of the deep posterior compartment of the leg
Flexor digitorum longus Tibialis posterior Flexor hallucis longus Popliteus
45
Origin and insertion of peroneal longus
Origin - head of the fibula Inserts - base of the 1st metatarsal and medial cuneiform
46
Origin and insertion of peroneal brevis
Origin - lower 2/3rd of the lateral fibula Inserts - base of 5th metatarsal
47
Origin and insertion of peroneal tertius
Origin - lower 1/3rd of anterior fibula and lower IOM (passes under extensor retinaculum) Inserts - base of 5th metatarsal
48
How does peroneal tertius differ from the other peroneal muscles?
Located in the anterior compartment, innervated by the deep peroneal nerve and runs under the extensor retinaculum
49
What vessels run deep to extensor hallucis longus in the leg?
Anterior tibial artery and vein (deep peroneal nerve runs deep to it)
50
How wound you test knee L3/4 reflex?
Describe test and adequately expose patient (entire thigh) Strike patellar tendon, looking for quadricep contraction
51
How wound you test ankle S1/2 reflex?
Describe test and adequately expose patient (entire leg), position foot pointing laterally and dorsiflexed Strike achilles tendon, looking for posterior calf contraction
52
Which muscles assist in dorsiflexion?
Tibialis anterior Extensor hallucis longus Extensor digitorum longus Peroneal tertius
53
What does the popliteal artery split into?
Anterior tibial artery Tibioperoneal trunk (further splits into the posterior tibial and peroneal arteries)
54
How do the arteries of the leg appear on angiogram?
Medial - posterior tibial artery Middle - peroneal artery Lateral - anterior tibial artery
55
Which nerve is located in the superficial posterior compartment of the leg?
medial sural cutaneous nerve
56
What does the anterior fascial septum of the leg divide?
Anterior and lateral compartments
57
What does the posterior facial septum of the leg divide?
Lateral and posterior compartments
58
What structures attach to the linea aspera?
Pectineus Adductors (magnus, brevis, longus) Vastas medialis & lateralis Intermuscular septa (lateral and medial) Short head biceps femoris Remember: PAVIS
59
How would you perform a leg fasciotomy?
Explain procedure and consent patient Prep & drape Decompress anterior & lateral compartments - anterolateral incision 2cm anterior to fibula (from level to tibial tuberosity to above ankle) Decompress two posterior compartments with posteromedial incision - from tibial tuberosity to 5cm above medial malleolus Debride necrotic tissues and leave open
60
Which leg muscles attach to the medial cuneiform?
Tibialis anterior Tibialis posterior Peroneus longus
61
What are the surface markings of the great saphenous vein?
Formed from the dorsal vein of the great toe joining the dorsal venous arch, it passes anterior to medial malleolus, runs up medial leg, runs posterior to medial epicondyle of the femur, ascends medial thigh, enters saphenous opening of the fascia lata to join the femoral vein within the femoral triangle
62
Which nerves form the sural nerve?
Medial sural cutaneous branch of the tibial nerve and the sural communicating branch of the common peroneal nerve
63
What gives rise to the saphenous nerve?
Femoral nerve
64
What are the 3 arches of the foot?
Medial longitudinal Lateral longitudinal Transverse
65
What forms the medial longitudinal arch of the foot?
Bones: calcaneum, talus, navicular, 3 cuneiforms, medial 3 metatarsals Ligaments: interosseous, spring Muscles: FHL, FDL, FDB, Tib ant/pos
66
What forms the lateral longitudinal arch of the foot?
Bones: calcaneum, cuboid, lateral 2 metatarsals Ligaments: long & short plantar Muscles: PL, FDL, FPB (to 4th and 5th digits)
67
What forms the transverse arch of the foot?
Bones: bases of metatarsal heads 1-5 Ligaments: interosseous Muscles: peroneus longus
68
What are the layers of the sole of the foot? (deep to superficial)
1. plantar and dorsal interossei, tendons of peroneus longus and tibialis posterior 2. FHB, adductor hallucis, flexor digiti minimi 3. Quadratus plantae, lumbricals, tendons of FDL and FHL 4. Abductor hallucis, abductor digiti minimi, flexor digitorum brevis
69
What arteries form the plantar arch?
Lateral plantar branch of the posterior tibial artery anastomoses with deep plantar branch of the dorsalis pedis
70
Testing motor L5 nerve root
EHL - big toe extension

MRCS Part B (7 decks)

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