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FRCEM Primary > Anatomy - Lower limb > Flashcards

Anatomy - Lower limb Flashcards

1
Q

Dermatomes of lower leg

A

L1-S1
L1 groin
L2 upper thigh
L3 Upper thigh obliquely to inner upper lower leg
L4 Mid way down upper out thigh down to side lower leg to big toe
L5 Outer lower leg to inner toes 2-4
S1 Little toe

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2
Q

Superficial cutaneous arteries of the anterior thigh come from

A

the femoral artery

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3
Q

The great saphenous vein arises from

A

medial end of dorsal venous arch on the foot

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4
Q

The great saphenous vein surface landmarks (3)

A

Anterior to medial malleolus
Posterior to patella anterior to medial epicondyle
Ascends anteromedial thigh

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5
Q

Great saphenous vein drains into

A

Femoral vein at the saphenous opening

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6
Q

Tributaries of great saphenous vein (7)

A

Ankle - medial marginal vein
Lower leg - anterior and posterior tibial veins
Thigh - accessory saphenous vein
Near the saphenous opening - superficial epigastric, superficial iliac circumflex, superficial external pudendal veins

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7
Q

Superficial Longitudinal lymph nodes

A

Lie along the saphenous vein

Drain superficial tissues of lower limb

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8
Q

Superficial Horizontal lymph nodes

A

Lie parallel to inguinal ligament

Drain from superficial tissues of lower trunk below umbilicus, buttock, external genitalia and lower half of anal canal

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9
Q

Deep lymph nodes

A

Medial to femoral vein
Drain all tissues deep to fascia lata of lower limb and superficial tissues and skin from heel and lateral aspect of the foot

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10
Q

Actions of sartorius (5)

A 
Flexion of hip
Abduction of the hip
Lateral rotation of the hip 
Flexion of the knee
Sitting cross legged
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11
Q

Nerve supply of sartorius

A

L2-L3 Femoral nerve

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12
Q

Action of Iliacus (1)

A

Flexion of the hip

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13
Q

Nerve supply of illiacus

A

L2 Femoral nerve

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14
Q

Action of Psoas major (2)

A

Flexion of hip

Postural muscle controlling trunk while standing

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15
Q

Nerve supply of Psoas major

A

L1-L3 Femoral nerve

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16
Q

Action of pectineus (2)

A

Adduction of the hip

Flexion of the hip

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17
Q

Nerve supply of pectineus

A

L2-L3 Femoral nerve, Obturator nerve

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18
Q 
Action of (3)
Quadriceps femoris
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
A

Extension of knee
Stabilisation of knee
Rectus weakly stabilises the hip

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19
Q 
Nerve supply of 
Quadriceps femoris
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
A

L2-L4 Femoral nerve

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20
Q

The femoral sheath is a prolongation of

A

extraperitoneal fascia

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21
Q

Surface markings of femoral sheath

A

Funnel shaped tube emerging from behind the inguinal ligament, ending 4cm inferiorly. Contains the femoral artery and vein, not the nerve

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22
Q

The femoral canal

A

is a short conical medial compartment of the femoral sheath that lies between the medial edge of the femoral sheath and the femoral vein. The space allows for femoral vein expansio with increased venous return from the leg

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23
Q

The femoral ring

A

is a 1cm opening at the abdominal end of the femoral canal

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24
Q

The femoral artery is a continuation of

A

the external iliac artery

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25
Q

The femoral artery starts at

A

the mid-inguinal point behind the inguinal ligament

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26
Q

The femoral vein lies

A

medially to the femoral artery in the groin

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27
Q

The femoral nerve is derived from

A

the posterior divisions of L2-L4

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28
Q

Surface markings of the femoral nerve

A

Passes under the inguinal ligament lateral to the femoral artery. 5cm below the ligament it divides into superficial and deep branches

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29
Q

The superficial branch of the femoral nerve splits into 4 branches

A

Medial cutaneous branch - supplies skin over medial thigh
Intermediate cutaneous branch - supplies skin over anterior thigh
2 muscular branches - pectineus and sartorius

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30
Q

The deep branch of the femoral nerve splits into 5 branches

A

4 muscular branches - quadriceps femoris

Saphenous nerve descending below the knee to supply skin over medial aspect of leg and foot

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31
Q

The patella ligament is a continuation of

A

The quadriceps tendon, formed from the 4 parts of quadriceps

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32
Q

The petella bone type

A

Sesamoid bone

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33
Q

Lateral patellar draw is prevented by

A

Medial patella ligament and vastus medialis

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34
Q

3 prime hip adductors

A

Adductor longus
Adductor brevis
Adductor magnus

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35
Q

Nerve supply of Adductor longus, brevis and magnus

A

L2-4 Obturator nerve

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36
Q

Action of obturator externus

A

Lateral rotation of hip

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37
Q

Nerve supply of obturator externus

A

L3-4 Obturator nerve

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38
Q

Main artery of the thigh and it’s main support

A

Profunda femoris - from femoral artery.

Supported by obturator artery

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39
Q

Obturator nerve supplies

A 
Muscles - Adducotr longus
Adductor brevis
Adductor magnus
Gracilis
Obturator externus
Pectineus
Cutaneous - Skin of medial thigh
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40
Q

Cutaneous innervation of hip and glutes is from

A

Posterior and anterior rami of lumbosacral nerves L4-S5

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41
Q

Action of gluteus maximus (2)

A

Extension of the hip

Lateral rotation of the hip

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42
Q

Nerve supply of gluteus maximus

A

L5-S2 Inferior gluteal nerve

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43
Q

Action of gluteus medius and gluteus minimus (3)

A

Abduction of hip
Medial rotation of the hip
Prevents pelvis tilting to unsupported side when walking

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44
Q

Nerve supply of gluteus medius and gluteus minimus

A

L5-S1 Superior gluteal nerve

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45
Q

Action of piriformis

A

Lateral rotation of hip

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46
Q

Nerve supply of piriformis

A

Branches of ventral rami of S1-2 from sacral plexus

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47
Q

Which muscles work synergistically as femoral lateral rotators and hip stabilisers (3)

A

Piriformis
Obturator internus
Quadratus femoris

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48
Q

Sciatic nerve originates from

A

Anterior primary rami of sacral plexus L4-S3

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49
Q

Landmarks of sciatic nerve

A

Leaves the pelvis throught the greater sciatic foramen and descends int he midline deep to gluteus maximus.
Divides into terminal branches tibial nerve and common peroneal nerve in mid-thigh

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50
Q

Safe IM injections in the buttock can be made in the

A

Superolateral quarter
Midpoint between spinal column and midaxillary line
Midpoint between iliac crest and greater trochanter

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51
Q

The bony acetabulum consists of (3)

A

Ileum (superior)
Ischium (postero-inferior)
Pubis (anterior)

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52
Q

Hip joint ligaments - Transverse ligament

A

Forms inferior margin

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53
Q

Hip joint ligaments - Ligamentum teres

A

Weakly attaches the floor of the acetabulum to the femoral head

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54
Q

Hip joint ligaments - provides main stability (3)

A

Iliofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament

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55
Q

Blood supply of the hip joint comes from

A

Circumflex femoral artery

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56
Q

Nerve supply of hip joint (3)

A

Branches of femoral, sciatic and obturator nerve

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57
Q

Hip movements - Flexion (5)

A 
0-120
Iliacus
Psoas major
(rectus femoris)
(sartorius)
(pectineus)
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58
Q

Hip movement - Extension (4)

A

0-20
Gluteus maximus
Hamstrings - Biceps femoris, Semimembranosus, Semitendinosis

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59
Q

Hip movements - Adduction (5)

A 
0-30
Adductor magnus
Adductor longus
Adductor brevis
(Gracilis)
(Pectineus)
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60
Q

Hip movements - Abduction (3)

A

0-45
Gluteus medius
Gluteus minimus
Tensor fascia latae

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61
Q

Hip movements - External rotation (7)

A 
0-45
Piriformis
Obturator internus
Obturator externus
Gemellus inferior
Gemellus superior
Quadratus femoris
Gluteus maximus
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62
Q

Hip movements - Internal rotation (3)

A

0-45
Tensor fascia latae
Gluteus medius
Gluteus minimus

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63
Q

Actions of Biceps femoris (2)

A

Extension of hip

Flexion of knee

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64
Q

Innervation of Biceps femoris

A

L5-S2 Sciatic nerve

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65
Q

Action of semitendinosus (2)

A

Extension of hip

Flexion of knee

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66
Q

Nerve supply of semitendinosus

A

L5-S2 Sciatic nerve

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67
Q

Action of Semimembranosus (2)

A

Extension of hip

Flexion of knee

68
Q

Nerve supply of semimebranosus

A

L5-S2 Sciatic nerve

69
Q

To test hamstrings

A

Flex at the waist, lie torso on the bed and stand on the floor. Flex knees and lift legs off the floor.

70
Q

In the posterior thigh the sciatic nerve supplies

A

Quadratus femoris
Obturator internus
Muscular branches to hamstrings

71
Q

Superolateral border of popliteal fossa

A

Biceps tendon

72
Q

Superomedial boundary of popliteal fossa

A

Semimebranosus

Semitendinosus

73
Q

Inferomedial boundary of popliteal fossa

A

Medial head of gastrocnemius

74
Q

Inferolateral boundary of popliteal fossa

A

Lateral head of gastrocnemius

75
Q

Roof of popliteal fossa

A

Skin and fascia

76
Q

Floor of popliteal fossa

A

Femur

Popliteus

77
Q

Neurovascular contents of popliteal fossa

A 
Deep to superficial:
Popliteal artery
Popliteal vein
Tibial nerve.
At the medial border beside biceps tendon is common peroneal nerve
78
Q

Action of popliteus

A

Initiation of knee flexion
Lateral rotation of femur on the tibia (unlocking the extended knee)
Posterior drawer of lateral meniscus in knee flexion

79
Q

Nerve supply of popliteus

A

L4-S1 Tibial nerve

80
Q

Screw home mechanism

A

The medial surface of the femoral epicondyle is larger than the lateral, so in the last 15 degrees of extension there is slight rotation to allow the femur to glide posteriorly on the tibia to allow full use of the medial surface. This is locked in place by the vastus medialis.

81
Q

The articular capsule of the knee has two openings for:

A

Laterally - popliteus

Anteriorly - to communicate with suprapatellar bursa

82
Q

Medial collateral ligament function

A

Resists valgus deformity

83
Q

Lateral collateral ligament function

A

Resists varus deformity

84
Q

Oblique popliteal ligament function

A

Strengthens the capsule posteriorly

85
Q

Anterior cruciate ligament function

A

Prevents posterior displacement of the femur on the tibia

86
Q

Posterior cruciate liagment

A

Prevents anterior displacement of the femur on the tibia

87
Q

What are menisci

A

Crescenteric fibrocartilages that act as shock absorbers and lubricate the joint

88
Q

Bursae of the knee that communicate with the knee joint (4)

A

Semimembranosus
Subcutaneous prepatellar
Subcutaneous infrapatellar
Deep infrapatellar

89
Q

Bursae of the knee that don’t communicate with the knee joint (4)

A

Suprapatellar
Popliteus
Anserine
Gastrocnemius

90
Q

Movements of the knee - Extension (1)

A

Quadriceps femoris

91
Q

Movement of the knee - Flexion (4)

A

Hamstrings
Gracilis
Gastrocnemius
Sartorius

92
Q

Movements of the knee - Internal rotation of the tibia (Unlocking) (1)

A

Popliteus

93
Q

Side to side stability of the knee is provided by

A

The collateral ligaments

94
Q

Anterposterior stability of the knee is provided by

A

The tibial spine and cruciate ligaments

95
Q

Action of tibialis anterior (2)

A

Dorsiflexion of ankle

Inversion of foot

96
Q

Innervation of tibialis anterior

A

L4-L5 deep peroneal nerve

97
Q

Action of Extensor hallucis longus (2)

A

Extension of big toe

Dorsiflexion of ankle

98
Q

Nerve supply of extensor hallucis longus

A

L5-S1 Deep peroneal nerve

99
Q

Action of Extensor digitorum longus (2)

A

Extension of lateral four digits

Dorsiflexion of ankle

100
Q

Nerve supply of Extensor digitorum longus

A

L5-S1 Deep peroneal nerve

101
Q

Action of peroneus tertius (2)

A

Dorsiflexion of ankle

Eversion of foot

102
Q

Nerve supply of peroneus tertius

A

L5-S1 Deep peroneal nerve

103
Q

Action of gracilis (3)

A

Adduction of hip
Flexion of hip
Medial rotation of hip

104
Q

Nerve supply of gracilis

A

L2-L3 Obturator nerve

105
Q

Site of suprapatella bursae

A

Between femur and quadriceps tendon

106
Q

Site of subcutaneous prepatellar bursae

A

Between skin and patella

107
Q

Site of subcutaneous infrapatellar bursae

A

Between skin and tibial tuberosity

108
Q

Site of deep intrapatellar bursae

A

Between patellar ligament and tibia

109
Q

Nerves of the dorsum of the foot (4)

A

Superficial peroneal nerve - everything else
Sural nerve Outside lateral edge of midfoot to base of little toe
Deep peroneal nerve - V shape from vertical middle of first and second toes back to mid foot
Saphenous nerve - medial half of ankle down to mid foot

110
Q

Nerves of the plantar surface of the foot (5)

A

Lateral plantar nerve - lateral 1/5 toes back to heel area
Sural nerve - lateral back quarter
Tibial nerve - heel area
Saphenous nerve - medial back quarter
Medial plantar nerve - first 3.5 toes back to heel

111
Q

Dorsalis pedis artery is a continuation of

A

the anterior tibial artery

112
Q

Surface marking of dorsalis pedis artery

A

Distal to the front of the ankle midway between the malleoli, flanked by tibialis anterior and extensor digitroum longus. It travels anteromedially down the dorsum of the foot to the base of the metatarsals before passing towards the sole at the first interosseous space

113
Q

Actions of Peroneus longus (2)

A

Eversion of foot

Plantarflexion of ankle

114
Q

Nerve supply of peroneus longus

A

L5-S2 Superficial peroneal nerve

115
Q

Insertion of Peroneus longus

A

Base of 1st metatarsal and medial cuneiform

116
Q

Actions of Peroneus brevis (2)

A

Eversion of foot

Plantarflexion of ankle

117
Q

Nerve supply of peroneus brevis

A

L5-S2 Superficial peroneal nerve

118
Q

Insertion of Peroneus brevis

A

Base of 5th metatarsal

119
Q

Peroneus longus and brevis tendons pass posteriorly to the lateral malleolus and are held in place by the peroneus retinaculum. They are commonly injured in

A

Ankle inversion injuries

120
Q

The calf muscles are divided into two groups

A

Superficial and deep

121
Q

Superficial calf muscle group contains (3)

A

Gastrocnemius
Soleus
Plantaris

122
Q

Deep calf muscle group contains (4)

A

Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior

123
Q

Action of gastrocnemius (2)

A

Plantar flexion of the foot

Flexion of the knee

124
Q

Nerve supply of gastrocnemius

A

S1-2 Tibial nerve

125
Q

Actions of soleus (2)

A

Plantar flexion of the foot

Muscle pump

126
Q

Nerve supply of soleus

A

S1-2 Tibial nerve

127
Q

Actions of flexor digitourm longus (2)

A

Flexion of the lateral 4 toes

Plantar flexion of the foot

128
Q

Nerve supply of flexor digitorum longus

A

S2-3 Tibial nerve

129
Q

Actions of Flexor hallucis longus (2)

A

Flexion of the great toe

Plantar flexion of the foot

130
Q

Nerve supply of flexor hallucis longus

A

S2-3 Tibial nerve

131
Q

Actions of tibialis posterior (2)

A

Plantar flexion of foot

Inversion of foot

132
Q

Nerve supply of tibialis posterior

A

L4-5 Tibial nerve

133
Q

The main blood supply to the foot is

A

the posterior tibial artery

134
Q

The posterior tibial artery is derived form

A

the popliteal artery

135
Q

Surface markings of the tibial nerve

A

Crosses the popliteal fossa and descends deep to soleus in the median plane of the calf. It passes behind the medial malleolus with the posterior tibial artery.

136
Q

The tibial nerve supplies all the

A

flexor compartment of the lower leg

137
Q

The sole has how many layers

A

4

138
Q

Tendons of Flexor digitorum longus and Flexor hallucis longus lie in which layer of the sole

A

2nd

139
Q

Tendons of tibialis posterior and peroneus longus lie in which layer of the sole

A

4th

140
Q

The neurovascular plane lies between which layers of the sole of the foot

A

first and second

141
Q

Ankle joint type

A

Synovial hinge joint

142
Q

Weight bearing surfaces int he ankle joint come from

A

Talus and tibia

143
Q

Stabilising surfaces in the ankle joint come from

A

Malleoli - they grip the talus as it moves anteriorly and posteriorly

144
Q

The deltoid ligament in the ankle stabalises

A

Medially

145
Q

Deltoid ligament in the ankle attachment sites

A

Proximally at medial malleolus

Distally at talus/calcaneus/navicular

146
Q

Lateral ligament in the ankle consists of

A

Anterior talofibular ligament - lateral malleolus to neck of talus
Posterior talofibular ligament - Malleolar fossa to lateral tubercle of talus
Calcaneofibular ligament - tip of lateral malleolus to lateral surface of calcaneous

147
Q

The axis of rotation of the ankle is

A

Horizontal

148
Q

The talus is wedge shaped which does what to ankle stability

A

The ankle is unstable in plantarflexion because the posterior end of talus is narrower and so doesn’t fill the mortise formed by the malleoli, allowing inversion, eversion, abduction and adduction.

149
Q

The interosseous plantar ligaments are important in

A

maintaining the arches of the foot

150
Q

The plantar calcaneonavicular ligament or spring ligament position

A

The sustentaculum tali of the calcaneous to the posterio-inferior surface of the navicular

151
Q

Function of the spring ligament

A

It supports the arch of the foot. It contains elastic fibres. If it yields, the patient is flat footed.

152
Q

Tarsal bones

A

Calcaneus Talus
Cuboid Navicular
Lateral cuneiform Intermediate cuneiform Medial cuneiform

153
Q

Subtalar joint involves

A

Talus
Calcaneous
Navicular

154
Q

Midtarsal joint comprises

A

Calcaneus
Cuboid
Talus
Navicular

155
Q

Foot movements - Inversion

A

Tibialis anterior

Tibialis posterior

156
Q

Foot movements - Eversion

A

Peroneus longus

Peroneus brevis

157
Q

When standing normally, whcih parts of the foot are in contact with the floor

A

The calcaneus and metatarsal heads

158
Q

Medial longitudinal arch comprises of (5)

A 
Calcaneus, 
Talus, 
Navicular, 
3 cuneiform
3 medial metatarsals
159
Q

Lateral longitudinal arch comprises of (3)

A

Calcaneus
Cuboid
2 lateral metatarsals

160
Q

Stability of the medial arch comes from (5)

A 
Spring ligament
Deltoid ligament
Tibialis anterior tendon
Tibialis posterior tendon
Peroneus longus
161
Q

Stability of the lateral arch comes from (3)

A

2 strong plantar ligaments
Peroneus longus tendon
Peroneus brevis tendon

162
Q

Damage to the femoral nerve causes (4)

A

Instability of the knee on climbing stairs
Numbness to the medial side of thigh and calf
Quadriceps muscle weakness and wasting
Loss of knee jerk

163
Q

Damage to the lateral cutaneous femoral nerve (1)

A

Anterolateral thigh burning, tingling or numbness

Symptoms exacerbated by standing, walking or hip extension

164
Q

Damage to Obturator nerve causes (3)

A

Exercise related groin pain
Severe - loss of adduction and internal rotation
Gait with externally rotated foot

165
Q

Damage to sciatic nerve causes (5)

A 
Weakness of knee flexion
Weakness of foot plantarflexion
Weak or absent knee jerk
Sciatica pain
Severe -  loss of sensation
166
Q

Damage to common peroneal nerve (3)

A

Foot drop
High stepping gait - loss of dorsiflexion
Decreased sensation to top of foot

FRCEM Primary (32 decks)

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