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LEA Practical 2 > LEA Written Quiz 10 > Flashcards

LEA Written Quiz 10 Flashcards

1
Q

What is the medial arm of the FHB from? Lateral?

A

Medial: slip from TP

Lateral: cuboid + lateral cuneiform

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2
Q

Combined tendons of FHB contribute to what?

A

Extensor expansion of hallux

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3
Q

Where does the oblique head of adductor hallucis originate? The transverse?

A

Oblique: MT 2-4 bases and shafts + peroneal sheath (from LONG PLANTAR lig)
Transverse: fibrous capsule + plantar MTPL of 3-5, deep transverse MT ligament

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4
Q

What is the origin of FDMB?

A

MT 5 base, perineal sheath, promontory of cuboid

*overlap 3rd PI ligament, covered by AbDM + PA

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5
Q

Where does FDMB insert?

A

MTPJ capsule, extensor expansion, MT 5 head, PP5 base (AbDM)

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6
Q

What does the superficial branch of the LPN innervate?

A

FDMB
4th dorsal IOM
3rd plantar IOM

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7
Q

What does the deep branch of the LPN innervate?

A

AdH
1-3 dorsal IOM
1-2 plantar IOM
2-4 lumbricals

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8
Q

What is the 1st and 2nd DAB innervated by?

A

DFN

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9
Q

What are the origins of dorsal IOM?

A

2 heads from adj. MT + perineal sheath

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10
Q

What are the origins of the plantar IOM?

A

medial side of MT 3-5 and peroneal sheathe

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11
Q

Where do IOM insert?

A

Sling portion of extensor expansion

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12
Q

What is the relationship of the IOM to the deep transverse metatarsal ligament?

A

IOM pass superiorly/dorsally to DTMTL

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13
Q

What is the action of IOM?

A

Simultaneously plantarflex MTPJS 2-5, dorsiflex IP and DP 2-5

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14
Q

Why no DIOM for 1st digit? Why 2 for 2nd digit?

A

1st digit has abductor hallucis

2nd digit ha 2 bc medial or lateral movement

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15
Q

What 5 things are composed of the extensor expansion?

A 
S/L extensor tendons
Interossei
Lumbricals
PA
Fascia dorsali pedis
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16
Q

Where is the proximal portion of the expansion sling? What direction does it run and what does it attach to?

A

MTPJ in sling

Fibers run transversely covering extensor tendons and attach to MTPJ capsule, deep transverse MT ligament, plantar MTPJL and PP on each side

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17
Q

What is the distal portion of the extensor wing formed by? Where does it run and attach to?

A

Formed by triangle sheets forming on dorsal edges to fuse w/ extensor tendons

Attached to sides of PP, distal is free

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18
Q

What is the purpose of the extensor expansion?

A

EDL to dorsiflex PP

Attachment for IOM and lumbricals

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19
Q

What do interossei and lumbricals attach to on extensor expansion?

A

Interossei sling

Lumbricals wing

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20
Q

What contributes to the EE on the hallux?

A

Dorsal- EHL (no EHB)
Medial- AbH + FHB (medial head)
Lateral- AdH+FHB (lateral head)

Only lateral sling attaches to DTMTL

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21
Q

What contributes to the EE on the 5th digit?

A

Dorsal EDL (no EDB)
Medial 4th Lumbrical + 3rd PI
Lateral- AdDM + FDMB

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22
Q

During heel strike, what muscles are active?

A

Anterior dorsiflexors to control descent of anterior foot

Lateral everters to prevent excessive inversion

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23
Q

What do weak ankle dorsiflexors result in? Paralyzed?

A

Weak - apropulsive gait

Paralyzed - high stoppage

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24
Q

What is the sequence of toes MT touching the ground during foot flat to midstance

A

MT 4 -> medial MT -> lateral hallux + toes

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25
Q

What are is compressed during foot flat to mid stance

A

medial longitudinal arch

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26
Q

During foot flat, what does the lateral compartment do? What does the superficial posterior compartment do?

A

Lateral aids in pronation

Superficial posterior compartment controls ankle dorsiflexion thru out midstance

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27
Q

What does deep posterior compartment do during foot flat?

A

Supports medial longitudinal arch against too much compression

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28
Q

During heel up/heel off, what is the sequence of leaving the ground?

A

Heel first to leave, followed by lateral digits

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29
Q

What is the windlass mechanism and when is it activated?

A

Activated during heel off/heel up

Supports the MLA, supports re-supination and stabilizing midfoot in preparation for forefoot propulsion

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30
Q

What does the triceps surae do during heel off/heel up?

A

Produce heel up/heel off

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31
Q

What do the TP/FHL/FDL + intrinsic muscles of the foot do during heel off/heel up?

A

Support MLA and toe flexors stabilize the digits against the ground as passive MTPJ dorisflexion

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32
Q

Paralysis of the posterior compartment results in what gait?

A

Apropulsive gait

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33
Q

What are the last digits to leave the ground during toe off?

A

Hallux or second digit

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34
Q

What do TP, FHL, FDL and intrinsic muscles of the foot do during toe off?

A

Support MLA and stabilizes toes against ground as passive MTPJ takes place

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35
Q

How does MLA during early stance phase change?

A

Heel strike, foot is supinated, everters counter the inversion

Foot becomes weigh bearing during foot flat, pronation + MLA flattens. Inverters moderate MLA compression

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36
Q

What happens in early stance phase to MLA during pronation?

A

MLA reduction

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37
Q

What do everters to to MLA during early stance phase?

A

flatten MLA

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38
Q

In late stance phase, what needs to happen for forefoot to become rigid level for propulsion?

A

Resupination needs to take place -> happens when inverters + digital plantar flexors + windlass mechanism work to heighten MLA

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39
Q

What happens in late stance phase to MLA during supination?

A

MLA accentuation

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40
Q

What do inverters and WM do to MLA in late stance phase?

A

heighten MLA

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41
Q

During initial/midswing swing phase, what does the anterior compartment do? What does it do during

A

Ensures foot clears the ground during intitial/midswing

Terminal swing readies the foot for heel strike

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42
Q

Destructive lesion to what nerve would lead to paralysis of ankle dorsiflexors? What would this lead to and what would be the compensatory gait?

A

deep fibular nerve

Toe drag

High steppage gait

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43
Q

What are the 3 muscles of the 3rd compartment?

A

FHB, ADH, FDMB

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44
Q

What it the innveration of the FHB?

A

MPN

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45
Q

What is the innervation of Adductor hallucis?

A

Deep branch of LPN

46
Q

What muscle is formed when some fibers of FDMB distinctly insert onto lateral MT 5?

A

Opponens digiti mini

47
Q

What are 2 extrinsic tendons and 2 intrinsic muscles in the 4th compartment?

A

TP, Peroneus longus, dorsal interosseous, plantar interosseous

48
Q

What is the origin of DIOM?

A

adjacent MT shafts 1-5

Peroneal sheath

49
Q

Where do DIOM insert?

A

MTPJ capsule, extensor expansion, PP base

Digit 2- both sides
Digit 3/4- lateral

50
Q

What is the innervation of DIOM?

A

LPN (deep 1-3, superficial 4)

1-2nd also DFN

51
Q

What is the origin of PIOM?

A

Medial surface of shaft, plantar aspect of base MT 3-5

52
Q

What is the innervation of the insertion of the PIOM?

A

MTPJ capsule, extensor expansion, medial PP base 3-5

53
Q

What is the innveration of the PIOM?

A

LPN (deep 1-2, superficial 3)

54
Q

What nerves supply the skin of the second digit?

A

Dorsomedial side- DFN
Dorsolateral side- SFN
Distal dorsal + plantar= MPN

55
Q

Skin of second digit is supplied by what nerve BRANCHES?

A

Dorsomedial side- 1 proper dorsal digital
Dorsolateral- 1 proper dorsal digital n.
Distal dorsum + plantar aspect of digit- 2 proper plantar digital nerve

56
Q

What position (o’clock) are the nerves for digital blocks?

A

10, 2 (2 PDDN)

4,77 (2 PPDN)

57
Q

What is supplied by the medial plantar nerve?

A 
Lab HD Baby
1st lumbrical
Abductor hallucis
FHB
FDB
58
Q

What is the rami of MPN?

A

L4-S3

59
Q

What cutaneous innervation is the MPN?

A

Sole, medial 3 toes, medial 4th toe, dorsum of 3 1/2 toes

60
Q

What is the relationship between the MPN and AbH? The fascia between AbH/FDB?

A

MPN courses DEEP to AbH to enter sole

Travels between fascial plane between AbH/FDB?

61
Q

At the diversion of AbH and FDB, what does the MPN turn into?

A

PPDN to medial side of the hallux

62
Q

At the MT bases, what does the MPN turn into?

A

3 common plantar nerves (each gives off 2 proper plantar digital nerveS)

63
Q

What is the course of the LPN?

A

Deep to AbH, pierces medial inter muscular septum, distally/laterally to FDB/QP, pierces lateral intermuscular septum, divides at MT 5 base

64
Q

What is Baxter’s nerve?

A

Inferior calcanea nerve, 1st branch of LPN

65
Q

What does the Baxter nerve innervate?

A

FDB, QP, AbDM

66
Q

Where are the two entrapment sites of Baxter’s nerve?

A

Site 1: lateral area between QP, thick fascia of AbdH

Site2: Anterior towards medial calcaneal process where spur is developed

67
Q

What is Morton’s neuroma?

A

Interdigital nerve entrapment - most often between 3rd common digital branch

68
Q

What is Mulder’s test?

A

For detecting Morton’s neuroma, compress forefoot w/ direct pressure

69
Q

What are the branches of the posterior tibial artery?

A 
Nutrient artery of tibia
Fibular artery
Communicating branch
Posterior medial malleolar
medial calcaneal branches
70
Q

What 3 muscles are supplied by the medial plantar ARTERY?

A

AbH
FDB
First DIOM

71
Q

What is the path of the LPA thru the plantar of the foot?

A 
Deep to AbH
Piece medial inter muscular septum
Run lateral/distal between FDB/QP
Pierces lateral inter muscular septum
PPDA to lateral side of 5th toe
goes to MT5 base to bc the DEEP PLANTAR ARCH
72
Q

What is the path of MPA thru the plantar of the foot?

A

Deep to AbH
Btw AbH and FDB
At MT1 base -> PPDA which joins 1st PMTA to form the PPDA to medial side of hallux

Superficial branches join the 1st-3rd plantar MTA

73
Q

Dorsal MTA run along where? Plantar MTA?

A

DMTA-> inter muscular spaces

PMTA-> along midline of MT shaft

74
Q

What do posterior dorsal perforating arteries come off? Posterior plantar perforating arteries?

A

PDPA-> dorsal MTA

PPPA-> Deep plantar arch

75
Q

The MPN lies ____ to the MPA.

The LPN lies ____ to the LPA

A

*artery lies on the outside, closest to the skin

MPA lies lateral to MPN

LPA lies medial to LPN

76
Q

What is the boundary between the superficial and deep veins?

A

Deep fascia

SF veins are in SF fascia w/ cutaneous

77
Q

Do superficial or deep veins have valves?

A

both, deep tend to hav more

78
Q

What kind of veins connect the SF to deep venous system?

A

Communicating/perforating w/ values to direct blood from SF to deep

79
Q

Two or more deep veins w/ an artery are called what?

A

Venae comitantes

80
Q

What major arteries do not have van comitantes?

A

Femoral
Deep femoral
Popliteal

81
Q

How does the dorsal SF venous system work?

A

Starts w/ dorsal digital veins and ends w/ great and large saphenous veins?

82
Q

How does the deep system dorsal venous work?

A

Veins w/ dorsalis pedis + branches

83
Q

How does the SF plantar venous system work?

A

Extremely superficial, intradermal + subnormal mesh

Joints dorsal on medial + lateral side of the foot

84
Q

How does the deep plantar venous system work?

A

Veins accompanying the medial/lateral plantar arteries and branches

85
Q

Why are valves in the pedal limbs?

A

Absence of valves

86
Q

What is the cause of varicose veins?

A

SF veins become distended bc valves incompetent

87
Q

What is lymphedema?

A

Swelling bc drainage function of lymphatics are disturbed

88
Q

Where do SF and deep systems of lymphatics unite?

A

Popliteal fossa

Femoral triangle

89
Q

What is the medial portion of the leg/foot draining?

A

Follows great saphenous vein
Drains SF medial dorsum of foot, medial leg, thigh

Superficial inguinal nodes

90
Q

What does the lateral portion of the leg/foot drain lymphatics?

A

Follows small saphenous vein
SF lateral dorsum of foot, posterior leg

Popliteal lymph nodes

91
Q

Lymphatics of the deep system terminate where?

A

Popliteal nodes

92
Q

From the popliteal nodes, lymph drains into what nodes?

A

Deep inguinal nodes

93
Q

What do the horizontal lymph nodes drain?

A

SF inguinnal lymph nodes, proximal group

94
Q

What do vertical lymph nodes drain?

A

SF inguinal lymph nodes, distal group

95
Q

Where the deep inguinal lymph nodes? What are they called? Where do they get lymph

A

Deep 1-3 nodes w/ femoral sheathe, medial to femoral

1st in femoral ring (gland of cloquet)

2nd/3rd within femoral canal

Recieve lymph from lower extremity and from popliteal nodes

96
Q

How does lymph rom the SF medial side of the foot drain?

A

Lymph from SF medial side of leg follow GSV > SF inguinal > external iliac

97
Q

How does lymph from SF lateral side of foot and posterior lateral leg drain?

A

Small saphenous > popliteal nodes > deep inguinal > external iliac

98
Q

The autonomic supply to limbs is exclusively ____

A

symphathic

99
Q

What spinal level do sympathetics of LL originate?

A

T10-L2

100
Q

How do postganglionic fibers leave the sympathetic trunk?

A

grey communicating rami

101
Q

Gray rami communicating along what portions of the sympathetic chains distribute postganglionic fibers to lower limb?

A

Lumbar and sacral ventral rami which form nerves

102
Q

After first traveling w/ peripheral nerves, post-ganglionic sympathetics then join?

A

Blood vessels

103
Q

What do postganlgionic symphonic fibers innervate in the lower limb?

A

Constrict of veins + arteries
Arrestor pili muscles-> sebaceous glands
Sweat glands

104
Q

What is keratoderma planters?

A

Keratin cracks + ulcerations due to sweat/oil gland dysfunction

105
Q

If there is damage to lumbar plexus, what muscle groups are affected?

A

Right hip flexors
Right knee extensors
Right adductors of thigh

106
Q

What skin is affected if lumbar plexus damage

?

A

Anterior/medial thigh
Anteriomedial+ posteriomedial leg
Medial plantar of foot including hallux

107
Q

If damage to right lumbar plexus, what would happen to sweat/vessels?

A

Decrease sweating

Vasodilation of right

108
Q

What arteries supply the interossei?

A

medial plantar for DI #1, LPA + dorsal MTA for DIOM 2-4, lateral plantar for all PIS

109
Q

What is claw foot primary and secondary deformity?

A

Primary - MTPJ hyperextension

Secondary - PIP flexion

110
Q

Where is hammer toe?

A

primary-PIPJ flexed

111
Q

Where is mallet toe?

A

primary- DIPJ flexed

112
Q

What is opponens digiti minimi?

A

distinct muscle belly that originates w/ FDMB and inserts onto lateral aspect of MT 5

LEA Practical 2 (9 decks)

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