Grays Review I Flashcards
A man’s foot is everted and plantar flexed. He has
- weak toe extension
- weak dorsiflexion and inversion of the foot
- loss of sensation of
- dorsum of the foot
- skin of sole
- lateral aspect of the foot
Which of the following structures is most likely injured?
- Lumbosacral trunk at linea terminalis
- L5 and S1
- Fibular division of teh sciatic nerve at the neck of the fibula
- Sciatic nerve injury at the gsf
- Tibial nerve in the popliteal fossa
Lumbosacral trunk (L4-5)
- Deep fibular nerve (L4-S1) is responsible for toe extension and ankle dorsiflexion
- L5 is responsible for dorsum sensation
- L4 is responsible for foot inversion via tibilas anterior muscle
Patient has pain in the backside, back of his thigh, leg, and side of foot. Also has a weakened Achilles’ tendon. What’s the most likely cause of injury?
- Disc lesion at L3-4
- Disc lesion at L4-5
- Disc lesion at L5-S1
- Disc lesion at S1-S2
- Gluteal crush syndrome of the sciatic nerve
Achilles’ tendon weakened -> S1
Disc lesion at L5-S1 would put the S1 root under tension. Whereas, a disc lesion at S1-2 in the sacrum is just unlikely to happen.
Man has pain radiating down the posterior aspect of his thigh and he has prififormis entrapment syndrome. Entrapment of which of the following nerves can mimic piriformis entrapment syndrome?L4, L5, S1, S2, S3
S1
Piriformis entrapment: sciatic nerve compressed when piriformis is contracted, leading to painful sensations in the gluteal area and posterior thigh&leg. It most frequently resembles a disc lesion at L5-S1, with compression of S1
A man has difficulty flexing and medially rotaitng his thigh when running. Which muscle is most likely damaged?
- Rectus femoris
- Tensor fasciae latae
- Vastus intermedius
- Semimembranosus
- Sartorius
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Tensor fasciae latae aids in flexing the thigh, as well as medial rotation and abduction.
Rectus femoris extends the hip
Vastus intermedius extends knee
Semimembranosus extends hip, flexes & medially rotates knee
Sartorius flexes and laterally rotates the hip, and medially rotates the knee.
If the femoral artery is occluded, what will provide collateral circulation to the thigh?
- Descending branch of lateral circumflex femoral
- Descending genicular
- Medial circumflex femoral
- First perforating branch of deep femoral
- Obturator artery
Descending branch of lateral circumflex femoral artery
A man is bitten on his posterior thigh by a dog and days later has swollen lymph nodes. Which gorup of nodes first receives lymph from the infected wound?
- External iliac
- Vertical group of superficial inguinal
- Deep inguinal
- Horizontal group of superficial inguinal
- Internal iliac
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the vertical group receives lymph from the superficial thigh
Infection from the lateral side of the foot will spread to the regional lymph nodes in which area?
- Lateral surface of thigh
- Medial malleolus, posteriorly
- Popliteal fossa
- Sole of the foot
- Superficial inguinal area
Popliteal fossa
Lymphatic drainage of the foot follows its venous drainage, and the small saphenous vein drains teh lateral foot & postero lateral leg into the popliteal vein in the popliteal fossa.
Which muscles contribute to the tendon that is struck in a patellar reflex test?
- Quadriceps femoris
- Quadratus femoris
- Sartorius
- Pectineus
- Biceps femoris
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Quadriceps femoris (biceps femoris, vastus lateralus, medius, and intermedius)
If you sit on a thumbtack and your buttock becomes painful and inflamed, which group of nodes will receive lymph from that infected wound?
Superficial gluteal region -> superficial horizontal group
(If it was deep gluteal, it’d be deep inguinal)
A man suffered from a kick to the side of his knee. He has a dark bruise just distal to the head of the fibula. Which of the following muscles will most likely be paralyzed?
- Tibialis anterior & extensor digitorum longus
- Tibialis posterior
- Soleus and gastrocnemius
- Plantaris and popliteus
- Flexor digitorum longus and flexor hallucis longus
Tibialis anterior & extensor digitorum longus
The common fibular nerve passes around the head of the fibula, then it gives off the deep and superficial fibular nerves. Only the first choice are supplied by either of these nerve branches (both are innervated by deep fibular)
Damage to the tibial nerve would most likely result in which of the following?
- Inability to extend leg at knee
- Foot drop
- Dorsiflexed and everted foot
- Plantarflexed and inverted foot
- Total inability to flex the leg at the knee joint
Dorsiflexed and everted foot.
Tibial nerve innervates posterior leg muscles (plantarflexors).
Patient has pain in his shin. He has weakness of dorsiflexion and impaired inversion of the foot. Which nerve serves the muscle involved in the painful swelling?
Deep fibular (peroneal) nerve.
It supplies the dorsiflexors via extensor hallucis longus & extensor digitorum longus. It also supplies tibialis anterior, an invertor of the foot. It also gives sensation to the skin between the first two toes.
A woman has lateral dislocation of the patella. Which of the following muscles requires strengthening in physical rehabilitation to prevent future dislocation of the patella?
- Vastus lateralis
- Vastus medialis
- Vastus intermedius
- Rectus femoris
- Patellar ligament
Vastus medialis inserts upon the medial aspect of the patella and draws it medially; strengthening this lessens lateral dislocation of the patella.
Foot drop, sensory loss of over the dorsum and lateral leg. What nerve was injured?
Because it’s foot drop (deep fib) AND dorsum sensory loss (superficial fib), it’s common fibular nerve.
A man’s foot landed in a hole –> externally rotated and everted ankle, medially twisted knee. He has tenderness over the righ tmedial malleolus and proximal lateral leg. He has a displaced fracture of the neck of right fibula and comminuted fracture of the tibial plafond and medial malleolus. Which is the most likely consequence of this injury?
- Weak ‘push off’ whiel walking and numbness over the posteromedial leg
- Weak ankle eversion and numbness over the dorsum
- High stepping gait and numbness over the dorsum and first web space of the foot
- Waddling gait and inability to feel pin prick over the anterolateral leg
- Swing-out gait and numbness over the medial leg
High stepping gait and numbness over the dorsum and first web space of the foot
The deep fibular nerve is a branch of the common fibular nerve and begins at about the level of the fibula neck. It supplies the foot extensors and innervates the first web space of the foot. Fracture at the fibula head can damage it -> high stepping gait
A man has tenderness over the medial and lateral side of the knee joint. A valgus stress test was positive. He has disruption of multiple ligament support structures. What other symptoms are most likely possible in the patient?
- Inability to extend knee
- Inability to flex knee
- Instability of the knee when walking down a flight of stairs
- Instability of the knee when walking up a flight of stairs
- Excessive extension of the knee and difficulty walking down stairs
Instability of the knee when walking up a flight of stairs
Positive valgus stress test means injury to the medial collateral ligament. Injuries to the MCL usually also involve the ACL. Climbing stairs pushes the femur posteriorly. ACL injury results in posterior displacement of the femur with difficulty climbign stairs.
The head of the talus has become displaced inferiorly, causing the medial longitudinal arch of the foot to fall. What would be the most likely cause?
- Tearing of the plantar calcaneonavicular (spring) ligament
- Fracture of the cuboid bone
- Interruption of the plantar aponeurosis
- Sprain of the anterior talofibular ligament
- Sprain of the deltoid ligament
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Tearing of the spring ligament
Spring ligament supports the head of the talus and maintains teh longitudinal arch of the foot; provides more active support than the plantar aponeurosis.
A muscle was reflected from the lateral side of the proximal phalanx, together with a sesamoid bone, upon which the muscle also inserted. What muscle was this?
Adductor hallucis inserts on the lateral side of the proximal phalanx of the great toe, and also ont eh lateral sesamoid bone.
It is supplied by the lateral plantar nerve.
What muscle arises from the fibula nad inserts upon the tuberosity at teh base of the 5th metatarsal bone?
Fibularis brevis; often involved in an inversion fracture of the foot
A woman has maximal tenderness inferior and anterior to the lateral malleolus. What ligament was likely injured?
Calcaneofibular ligament is inferior and anterior to the lateral malleolus and connects the lateral malleolus to the calcaneus
