Clinical Notes

Question 1

Femoral Hernia

Answer 1

Femoral ring: Weak area in anterior abdominal wall where a loop of small intestine can protrude into femoral canal
This is due to the space the Rosenmüller’s lymph node provides

Question 2

Hasselbach’s Triangle

Answer 2

Triangular area on the inferior interior aspect of the anterior abdominal wall within groin

Question 3

Direct Inguinal Herniae

Answer 3

Abdominal wall is weak and allows for part of the intestine to push through the abdominal wall through Hasselbach’s triangle

Question 4

Indirect Inguinal Herniae

Answer 4

The herniae passes through laterally of Hesselbach’s triangle (into the deep ingunial ring)

Question 5

Anterior Hip Dislocation

Answer 5

Affects femoral nerve and lateral femoral cutaneous nerve

Question 6

Meralgia Paresthetica

Answer 6

Compression of lateral femoral cutaneous nerve as it passes under the inguinal ligament causing pain

Question 7

Cannulation of the femoral artery

Answer 7

Palpation of the A. 2-3 cm inferior to midpoint of inguinal ligament and between ASIS and pubic tubercle
Used for radiographic visualization of the left heart and coronary vessels

Question 8

Femoral bleeding

Answer 8

To stop bleeding, compress the femur head that lies posterior to the femoral artery

Question 9

Necrosis at hip/ arterial supply issue at femoral head

Answer 9

Caused by an issue to the medial circumflex femoral artery

Question 10

Great Saphenous vein clinical use

Answer 10

Can be used to administer blood, electrolytes, and drugs

You can have a “saphenous cutdown”, make an incision anterior to medial malleolus for access to the venous system

Question 11

Saphenous Nerve damage

Answer 11

Could be due to the cutdown of the saphenous vein, nicking the nerve causing pain along the medial border of the foot as a result and lower extremity numbness

Question 12

Damage to proximal femur

Answer 12

Could injure the profunda femoris, the deep branch of the femoral artery that runs along the shaft of the femur

Question 13

Superficial inguinal lymph nodes

Answer 13

Palpable lymph nodes along the medial thigh that is used to asses infection in that particular area

Question 14

Deep medial thigh injury

Answer 14

Would most likely injure the apex of the femoral triangle leading to exsanguination

Question 15

Saphena Varix

Answer 15

Saphenous vein becomes dilated at terminal part so that the cusps of the of the valves do not close, as a result, blood flows inferiorly in the veins and edema occurs in the femoral triangle

Question 16

Locating femoral vein

Answer 16

Can be found by feeling the pulsations of the femoral artery which is immediately lateral to vein and located inferior to the inguinal ligament

Question 17

Cannulation of Femoral vein

Answer 17

Right cardiac angiography is done by placing catheter in vein as it passes through femoral triangle to get pressure readings from the chambers of the right side of the heart and pulmonary artery.
Vein can also be used fort the administration of fluids

Question 18

Hernia description

Answer 18

A protrusion in the abdominal viscera that pops out of the weak femoral rings into the femoral canal. The hernia is bound by the femoral vein laterally and the lacunar ligament medially.
it compresses contents of the femoral canal and distends the wall of the canal

Question 19

Chondromalacia patella

Answer 19

Knee cap is shifted laterally and in order to fix it you must either do either or both of:

1) Stretch illiotibial band
2) Strengthen the vastus medialis to pull the patella more medially, since the lateral vastus tends to dominate more

Question 20

Westphal’s sign

Answer 20

Decrease or absence of the patellar tendon reflex. Due to the compromise of the of the L2- L4 spinal cord segments

Question 21

Calcanceal tendon reflex

Answer 21

Tendon tests the S1 and S2 nerve roots. If the nerve root is cut or compressed then the ankle reflex is absent

Question 22

Psoas Abscess

Answer 22

The transversalis fascia of the abdominal wall is continuous with the psoa fascia, forming a fascial covering on the psoas major that goes into the anterior region of thigh. TB or Crohn’s disease can form this psoa abscess which can pass through the psoas and their fascia causing severe pain at the hip, thigh, or knee joint. Should be considered if edema is in those spots

Question 23

Osgood-Schlatter Disease

Answer 23

Knee pain in adolescents, which is the cause of inflammation just below the attachment of the patellar tendon to the tibia (tibial tuberosity)
Sometimes bone growth happens as a result from the gap forming between tendon and tibia

Question 24

Patellar Ossification Abnormality

Answer 24

The patella ossifies between 3rd-6th year and become one bone. If they remain separate bones you can end up with a bipartite or tripartite patella, making it look fractured.
This is usually an issue that happens at ossification centers

Question 25

Quadricep Paralysis

Answer 25

A person with paralyzed quadriceps cannot extend leg against resistance and usually pushes on the distal end of the thigh during walking to prevent inadvertent flexion at the knee joint
Can happen from having a weak vastus medialis or lateralis which can result in abnormal patellar movement and loss of joint stability

Question 26

Patellar Fracture

Answer 26

Direct blow can result in two or more fractures. A a transverse patellar fracture can result from a blow to the knee or sudden contraction of the quads due to a fall/slip. The proximal fragment is pulled superiorly with the quadricep tendon and the distal fragment stays with the patellar ligament

Question 27

Groin Pull

Answer 27

Strain and tearing of the proximal attachment of the anteromedial thigh muscles. The flexor and thigh muscles are usually the culprits. The proximal attachments of these muscles are in the ingluinal region (groin), which is the junction of the thigh and trunk.
Usually occur with sprinting or extreme stretching (gymnastics).

Question 28

What are contusions?

Answer 28

Cause bleeding from ruptured capillaries and infiltration of blood into the muscles, tendons, and other soft tissues

Question 29

Iliac Crest Contusion

Answer 29

Occurs at the anterior part where the sartorious attached to ASIS, common in collision sports

Question 30

“Charley Horse”

Answer 30

Cramping of thigh due to ischemia or contusion and rupture of blood vessels that form a hematoma. Usually due to tearing of fibers/hematomas in quadriceps
Localized pain and stiffness after trauma