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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
The femoral artery starts at
the mid-inguinal point behind the inguinal ligament
26
The femoral vein lies
medially to the femoral artery in the groin
27
The femoral nerve is derived from
the posterior divisions of L2-L4
28
Surface markings of the femoral nerve
Passes under the inguinal ligament lateral to the femoral artery. 5cm below the ligament it divides into superficial and deep branches
29
The superficial branch of the femoral nerve splits into 4 branches
Medial cutaneous branch - supplies skin over medial thigh Intermediate cutaneous branch - supplies skin over anterior thigh 2 muscular branches - pectineus and sartorius
30
The deep branch of the femoral nerve splits into 5 branches
4 muscular branches - quadriceps femoris | Saphenous nerve descending below the knee to supply skin over medial aspect of leg and foot
31
The patella ligament is a continuation of
The quadriceps tendon, formed from the 4 parts of quadriceps
32
The petella bone type
Sesamoid bone
33
Lateral patellar draw is prevented by
Medial patella ligament and vastus medialis
34
3 prime hip adductors
Adductor longus Adductor brevis Adductor magnus
35
Nerve supply of Adductor longus, brevis and magnus
L2-4 Obturator nerve
36
Action of obturator externus
Lateral rotation of hip
37
Nerve supply of obturator externus
L3-4 Obturator nerve
38
Main artery of the thigh and it's main support
Profunda femoris - from femoral artery. | Supported by obturator artery
39
Obturator nerve supplies
``` Muscles - Adducotr longus Adductor brevis Adductor magnus Gracilis Obturator externus Pectineus Cutaneous - Skin of medial thigh ```
40
Cutaneous innervation of hip and glutes is from
Posterior and anterior rami of lumbosacral nerves L4-S5
41
Action of gluteus maximus (2)
Extension of the hip | Lateral rotation of the hip
42
Nerve supply of gluteus maximus
L5-S2 Inferior gluteal nerve
43
Action of gluteus medius and gluteus minimus (3)
Abduction of hip Medial rotation of the hip Prevents pelvis tilting to unsupported side when walking
44
Nerve supply of gluteus medius and gluteus minimus
L5-S1 Superior gluteal nerve
45
Action of piriformis
Lateral rotation of hip
46
Nerve supply of piriformis
Branches of ventral rami of S1-2 from sacral plexus
47
Which muscles work synergistically as femoral lateral rotators and hip stabilisers (3)
Piriformis Obturator internus Quadratus femoris
48
Sciatic nerve originates from
Anterior primary rami of sacral plexus L4-S3
49
Landmarks of sciatic nerve
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
50
Safe IM injections in the buttock can be made in the
Superolateral quarter Midpoint between spinal column and midaxillary line Midpoint between iliac crest and greater trochanter
51
The bony acetabulum consists of (3)
Ileum (superior) Ischium (postero-inferior) Pubis (anterior)
52
Hip joint ligaments - Transverse ligament
Forms inferior margin
53
Hip joint ligaments - Ligamentum teres
Weakly attaches the floor of the acetabulum to the femoral head
54
Hip joint ligaments - provides main stability (3)
Iliofemoral ligament Pubofemoral ligament Ischiofemoral ligament
55
Blood supply of the hip joint comes from
Circumflex femoral artery
56
Nerve supply of hip joint (3)
Branches of femoral, sciatic and obturator nerve
57
Hip movements - Flexion (5)
``` 0-120 Iliacus Psoas major (rectus femoris) (sartorius) (pectineus) ```
58
Hip movement - Extension (4)
0-20 Gluteus maximus Hamstrings - Biceps femoris, Semimembranosus, Semitendinosis
59
Hip movements - Adduction (5)
``` 0-30 Adductor magnus Adductor longus Adductor brevis (Gracilis) (Pectineus) ```
60
Hip movements - Abduction (3)
0-45 Gluteus medius Gluteus minimus Tensor fascia latae
61
Hip movements - External rotation (7)
``` 0-45 Piriformis Obturator internus Obturator externus Gemellus inferior Gemellus superior Quadratus femoris Gluteus maximus ```
62
Hip movements - Internal rotation (3)
0-45 Tensor fascia latae Gluteus medius Gluteus minimus
63
Actions of Biceps femoris (2)
Extension of hip | Flexion of knee
64
Innervation of Biceps femoris
L5-S2 Sciatic nerve
65
Action of semitendinosus (2)
Extension of hip | Flexion of knee
66
Nerve supply of semitendinosus
L5-S2 Sciatic nerve
67
Action of Semimembranosus (2)
Extension of hip | Flexion of knee
68
Nerve supply of semimebranosus
L5-S2 Sciatic nerve
69
To test hamstrings
Flex at the waist, lie torso on the bed and stand on the floor. Flex knees and lift legs off the floor.
70
In the posterior thigh the sciatic nerve supplies
Quadratus femoris Obturator internus Muscular branches to hamstrings
71
Superolateral border of popliteal fossa
Biceps tendon
72
Superomedial boundary of popliteal fossa
Semimebranosus | Semitendinosus
73
Inferomedial boundary of popliteal fossa
Medial head of gastrocnemius
74
Inferolateral boundary of popliteal fossa
Lateral head of gastrocnemius
75
Roof of popliteal fossa
Skin and fascia
76
Floor of popliteal fossa
Femur | Popliteus
77
Neurovascular contents of popliteal fossa
``` Deep to superficial: Popliteal artery Popliteal vein Tibial nerve. At the medial border beside biceps tendon is common peroneal nerve ```
78
Action of popliteus
Initiation of knee flexion Lateral rotation of femur on the tibia (unlocking the extended knee) Posterior drawer of lateral meniscus in knee flexion
79
Nerve supply of popliteus
L4-S1 Tibial nerve
80
Screw home mechanism
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
The articular capsule of the knee has two openings for:
Laterally - popliteus | Anteriorly - to communicate with suprapatellar bursa
82
Medial collateral ligament function
Resists valgus deformity
83
Lateral collateral ligament function
Resists varus deformity
84
Oblique popliteal ligament function
Strengthens the capsule posteriorly
85
Anterior cruciate ligament function
Prevents posterior displacement of the femur on the tibia
86
Posterior cruciate liagment
Prevents anterior displacement of the femur on the tibia
87
What are menisci
Crescenteric fibrocartilages that act as shock absorbers and lubricate the joint
88
Bursae of the knee that communicate with the knee joint (4)
Semimembranosus Subcutaneous prepatellar Subcutaneous infrapatellar Deep infrapatellar
89
Bursae of the knee that don't communicate with the knee joint (4)
Suprapatellar Popliteus Anserine Gastrocnemius
90
Movements of the knee - Extension (1)
Quadriceps femoris
91
Movement of the knee - Flexion (4)
Hamstrings Gracilis Gastrocnemius Sartorius
92
Movements of the knee - Internal rotation of the tibia (Unlocking) (1)
Popliteus
93
Side to side stability of the knee is provided by
The collateral ligaments
94
Anterposterior stability of the knee is provided by
The tibial spine and cruciate ligaments
95
Action of tibialis anterior (2)
Dorsiflexion of ankle | Inversion of foot
96
Innervation of tibialis anterior
L4-L5 deep peroneal nerve
97
Action of Extensor hallucis longus (2)
Extension of big toe | Dorsiflexion of ankle
98
Nerve supply of extensor hallucis longus
L5-S1 Deep peroneal nerve
99
Action of Extensor digitorum longus (2)
Extension of lateral four digits | Dorsiflexion of ankle
100
Nerve supply of Extensor digitorum longus
L5-S1 Deep peroneal nerve
101
Action of peroneus tertius (2)
Dorsiflexion of ankle | Eversion of foot
102
Nerve supply of peroneus tertius
L5-S1 Deep peroneal nerve
103
Action of gracilis (3)
Adduction of hip Flexion of hip Medial rotation of hip
104
Nerve supply of gracilis
L2-L3 Obturator nerve
105
Site of suprapatella bursae
Between femur and quadriceps tendon
106
Site of subcutaneous prepatellar bursae
Between skin and patella
107
Site of subcutaneous infrapatellar bursae
Between skin and tibial tuberosity
108
Site of deep intrapatellar bursae
Between patellar ligament and tibia
109
Nerves of the dorsum of the foot (4)
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
Nerves of the plantar surface of the foot (5)
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
Dorsalis pedis artery is a continuation of
the anterior tibial artery
112
Surface marking of dorsalis pedis artery
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
Actions of Peroneus longus (2)
Eversion of foot | Plantarflexion of ankle
114
Nerve supply of peroneus longus
L5-S2 Superficial peroneal nerve
115
Insertion of Peroneus longus
Base of 1st metatarsal and medial cuneiform
116
Actions of Peroneus brevis (2)
Eversion of foot | Plantarflexion of ankle
117
Nerve supply of peroneus brevis
L5-S2 Superficial peroneal nerve
118
Insertion of Peroneus brevis
Base of 5th metatarsal
119
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
Ankle inversion injuries
120
The calf muscles are divided into two groups
Superficial and deep
121
Superficial calf muscle group contains (3)
Gastrocnemius Soleus Plantaris
122
Deep calf muscle group contains (4)
Popliteus Flexor hallucis longus Flexor digitorum longus Tibialis posterior
123
Action of gastrocnemius (2)
Plantar flexion of the foot | Flexion of the knee
124
Nerve supply of gastrocnemius
S1-2 Tibial nerve
125
Actions of soleus (2)
Plantar flexion of the foot | Muscle pump
126
Nerve supply of soleus
S1-2 Tibial nerve
127
Actions of flexor digitourm longus (2)
Flexion of the lateral 4 toes | Plantar flexion of the foot
128
Nerve supply of flexor digitorum longus
S2-3 Tibial nerve
129
Actions of Flexor hallucis longus (2)
Flexion of the great toe | Plantar flexion of the foot
130
Nerve supply of flexor hallucis longus
S2-3 Tibial nerve
131
Actions of tibialis posterior (2)
Plantar flexion of foot | Inversion of foot
132
Nerve supply of tibialis posterior
L4-5 Tibial nerve
133
The main blood supply to the foot is
the posterior tibial artery
134
The posterior tibial artery is derived form
the popliteal artery
135
Surface markings of the tibial nerve
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
The tibial nerve supplies all the
flexor compartment of the lower leg
137
The sole has how many layers
4
138
Tendons of Flexor digitorum longus and Flexor hallucis longus lie in which layer of the sole
2nd
139
Tendons of tibialis posterior and peroneus longus lie in which layer of the sole
4th
140
The neurovascular plane lies between which layers of the sole of the foot
first and second
141
Ankle joint type
Synovial hinge joint
142
Weight bearing surfaces int he ankle joint come from
Talus and tibia
143
Stabilising surfaces in the ankle joint come from
Malleoli - they grip the talus as it moves anteriorly and posteriorly
144
The deltoid ligament in the ankle stabalises
Medially
145
Deltoid ligament in the ankle attachment sites
Proximally at medial malleolus | Distally at talus/calcaneus/navicular
146
Lateral ligament in the ankle consists of
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
The axis of rotation of the ankle is
Horizontal
148
The talus is wedge shaped which does what to ankle stability
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
The interosseous plantar ligaments are important in
maintaining the arches of the foot
150
The plantar calcaneonavicular ligament or spring ligament position
The sustentaculum tali of the calcaneous to the posterio-inferior surface of the navicular
151
Function of the spring ligament
It supports the arch of the foot. It contains elastic fibres. If it yields, the patient is flat footed.
152
Tarsal bones
Calcaneus Talus Cuboid Navicular Lateral cuneiform Intermediate cuneiform Medial cuneiform
153
Subtalar joint involves
Talus Calcaneous Navicular
154
Midtarsal joint comprises
Calcaneus Cuboid Talus Navicular
155
Foot movements - Inversion
Tibialis anterior | Tibialis posterior
156
Foot movements - Eversion
Peroneus longus | Peroneus brevis
157
When standing normally, whcih parts of the foot are in contact with the floor
The calcaneus and metatarsal heads
158
Medial longitudinal arch comprises of (5)
``` Calcaneus, Talus, Navicular, 3 cuneiform 3 medial metatarsals ```
159
Lateral longitudinal arch comprises of (3)
Calcaneus Cuboid 2 lateral metatarsals
160
Stability of the medial arch comes from (5)
``` Spring ligament Deltoid ligament Tibialis anterior tendon Tibialis posterior tendon Peroneus longus ```
161
Stability of the lateral arch comes from (3)
2 strong plantar ligaments Peroneus longus tendon Peroneus brevis tendon
162
Damage to the femoral nerve causes (4)
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
Damage to the lateral cutaneous femoral nerve (1)
Anterolateral thigh burning, tingling or numbness | Symptoms exacerbated by standing, walking or hip extension
164
Damage to Obturator nerve causes (3)
Exercise related groin pain Severe - loss of adduction and internal rotation Gait with externally rotated foot
165
Damage to sciatic nerve causes (5)
``` Weakness of knee flexion Weakness of foot plantarflexion Weak or absent knee jerk Sciatica pain Severe - loss of sensation ```
166
Damage to common peroneal nerve (3)
Foot drop High stepping gait - loss of dorsiflexion Decreased sensation to top of foot

FRCEM Primary (32 decks)

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