Leg and Head/Neck Anatomy Flashcards
The lumbar plexus (L2,3,4) gives what 3 major nerves of the lower extremity?
Obturator, femoral, and lateral cutaneous nerve of the thigh
What is the continuation and branch of the sciatic nerve?
Tibial and common fibular
What nerve roots for the sciatic nerve?
Sacral plexus, L4, L5, S1, S2, S3
What muscle group does the femoral nerve supply?
Anterior thigh
What are ALL of the anterior muscles of the thigh?
Iliopsoas
Sartorius
Quadricepts
What are the quadricepts?
Vastus medialis, intermedius, and lateralis as well as rectus femoris
What is the function of the anterior thigh muscles?
Flexion of hip joint (thigh) and extension of the knee joint (leg)
What are the roots of the femoral nerve?
Lumbar plexus L 2, 3, 4
The femoral nerve runs into what cutaneous nerve?
Saphenous
What is the function of the medial thigh muscles?
Adduction
What are the muscles of the medial thigh compartment?
Pectineus, obturator externis, gracilis, adductor longus, adductor brevis, and 1/2 of adductor magnus magnus
What nerve supplies the medial thigh?
Obturator nerve
What group of muscles does the sciatic nerve supply?
Hamstrings (posterior thigh)
What muscles make up the hamstrings?
Bicepts femoris, semitendinosus, semimembranosus, 1/2 of adductor magnus
What is the function of the hamstrings?
Extensor of hip (thigh) and flexor of knee (leg)
What muscles are supplied by superior gluteal nerve?
Gluteus medius, gluteus minimus, and tensor fasciae latae
What does the sciatic nerve bifurcate into?
Tibial and common fibular nerves
What nerve supplies obturator internus and superior gemellus?
Nerve to obturator internus
What does the nerve to quadratus femoris supply?
Quadratus femoris and inferior gemellus
What muscles does the superficial fibular nerve supply?
Fibularis longus
Fibularis brevis
What is the function of the lateral muscles of the leg?
Eversion
The anterior compartment of the leg is supplied by which nerve?
Posterior fibular nerve
What muscles are included in the anterior leg compartment?
Tibialis anterior
Extensor digitorum
Extensor halluces longus
Fibularis tertius
What is the function of the anterior leg compartment?
Dorsiflexion of the ankle and extension of the toes
What are the superficial muscles of the posterior leg?
Gastrocnemius
Soleus
Plantaris
What are the deep muscles of the posterior leg
Flexor hallucis longus
Flexor digitorum
Tibialis posterior
What is the main function of posterior leg muscles?
Plantar flexion of ankle (also inversion)
What nerve supplies the posterior leg muscles?
Tibial n.
What are the tarsal bones?
Tallus Calcaneous Cuboid Medial, intermediate, and lateral cuneiform Navicular
What is the articulation point of the ankle?
Trochlea on the tallus
The tubercle of the 5th metatarsal is an attachment site for the tendon of which muscle?
Fibularis brevis
The attachment point for the fibularis longus is the:
Cuboid groove
The flexor hallucis longus tendon attaches on the:
Calcaneus sustentaculum tali
Chopart’s amputation cuts the foot:
between the tarsal bones at the transverse tarsal joint
Lisfranc’s amputation cuts the foot:
At the tarsometatarsal joint
What joint allows inversion/eversion of ankle?
Subtalar joint
What are two commonly injured ligaments in the ankle (usually an inversion injury)?
Anterior talofibular ligament, calcaneofibular ligament
What strong ligament helps to support the medial side of the ankle and can be injured in an eversion injury?
Deltoid ligament
A Pott’s ankle fracture involves what done?
Inferior fibula
What tendon travels lateral to medial under the long plantar ligament to attach to the cuboid?
Fibularis longus
The anterior tibial artery becomes what artery in the foot?
Dorsalis pedis
What nerve supplies the patch of skin between the first and second toes?
Deep fibular
What nerve supplies most cutaneous innervation to the dorsum of the foot?
Superficial fibular nerve
What nerve supplies the patch of skin on the lateral side of the foot?
Dorsal lateral cutaneous nerve of the foot
What two nerves supply the bottom of the foot except the heel?
Medial and lateral plantar nerve
What cutaneous nerve supplies the anterior and medial side of the leg?
Saphenous
What are the muscles in the first layer of the sole of the foot?
Flexor digitorum brevis
Abductor hallucis
Adbuctor digiti minimi
What are the muscles in the second layer of the sole of the foot?
Flexor digitorum longus
Lumbricals
Quadratus plantae
What are the muscles in the third layer of the sole of the foot?
Flexor digiti minimi
Flexor hallucis brevis
Adductor hallucis
What are the muscles in the fourth layer of the sole of the foot?
Plantar interossei (PAD) Dorsal interossei (DAB)
What ligaments make up the lateral ligament of the ankle?
Anterior and posterior tibiofibular,
calcaneofibular
What ligament provides passive support for the longitudinal arch of the foot?
Long plantar ligament
What is the “Spring” ligament and what does it support?
The plantar calcaneonavicular ligament, the head of the tallus
What are the intrinsic muscles of the dorsum of the foot?
Extensor digitorum/hallucis brevis, and the dorsal interosseus muscles
The digital bands of the plantar aponeurosis are connected by the:
Superficial transverse metatarsal ligament
What are the primary hip flexors?
Iliopsoas primarily, also pectineus and sartorius
What are the primary hip extensors?
Gluteus maximus and hamstrings
What vein runs from the lateral foot up the posterior leg to the popliteal fossa?
Small saphenous vein
What vein runs from the dorsum of the foot up the medial leg and thigh?
Great saphenous vein
Where does the iliopsoas attach on the thigh?
Lesser trochanter
Where is the adductor tubercle? What muscle inserts here?
Above the medial epicondyl, adductor magnus
What is the area of the femur leftover from the obturator branch feeding the head of the femur in children?
Fovea capitis
What is the tubercle just below the greater trochanter on the posterior femur?
Quadrate tubercle
If the angle of the femur is >135 degrees the knees tilt in and we call this:
Coxa valga (genu varum)
If the angle of the femur is <120 degrees the knees tilt out and we call this:
coxa vara (genu valgum)
Disease in which the head of the femur is not perfused resulting in bone loss
Perthes Disease
What are the three muscles that attach at the pes anserinus?
Sartorius
Gracilis
Semitendinosus
What are the borders of the femoral triangle?
Inguinal ligament, sartorius, adductor longus
What is the floor of the femoral triangle made of?
iliopsoas and pectineus
What are the contents of the femoral triangle?
Femoral nerve, artery vein, and canal
What are the boundaries of the popliteal fossa?
bicepts femoris, semimembranosus/tendinosus, gastrocenemius
What nerves form the sural nerve?
Tibial (medial sural cutaneous) and common fibular (Lateral sural cutaneous, then sural communicating)
What are the contents of the popliteal fossa?
Tibial/common fibular nerve,
Popliteal and short saphenous veins
Popliteal artery
What are the branches of the profunda femoris?
Medial and Lateral circumflex femoral and perforating branches
What are the roots of the femoral and obturator nerve?
L2,3,4
What are the names of the anastimoses around the head of the femur and the knee?
Cruciate, genicular
Patellar dislocation is almost always in a ___ direction
Lateral, due to vastus lateralis
Scar tissue creating a bump below the patella due to excertion during development is called:
Osgood-Schlatter Disease
Describe the Trandelenburg sign
Instability of the pelvis when walking due to paralized superior gluteal nerve
What is the name for the fibro-cartilagenous edge of the hip’s acetabulum?
Acetabular labrum
What is the inner, working part of the acetabulum? What is the other part, where there is a deficiency in cartilage?
Lunate surface
Synovial membrane
What are the three major ligaments (zona orbicularis) to the head of the femur?
Iliofemoral
Ischiofemoral
Pubofemoral
What ligament supports the medial rotators (G. medius and minimus) of the hip?
Iliofemoral ligament
If the femoral artery is injured, what vessel can supply collateral circulation to the hip?
Inferior gluteal from internal iliac
What is the name of the small arteries which travel inside the synovial folds?
Retinacular arteries
What is the at-risk structure in a posterior hip dislocation?
Sciatic nerve
What is the opening in the fascial late thru which the great saphenous vein travels to join the femoral?
Fossa ovalis
What is the major supportive structure of the knee?
Quadricept and patellar ligament anteriorly
Reduced joint space in the knee is a common presentation of:
Osteoarthritis
What is the “unhappy triad”?
ACT, medial meniscus, and medial collateral ligament
What ligament connects the medial and lateral menisci of the knee?
Transverse genicular ligament
What tendon connects to the lateral femoral condyl inside the joint capsule of the knee?
Popliteus
Anterior drawer tests____, while posterior drawer tests the ___
ACL, PCL
Lymph from the lateral foot drains to which lymph nodes?
Popliteal
The small saphenous vein runs on the ___ side of the leg, and the great saphenous runs on the ___ side
Lateral, medial
What legaments span the patella, before the MCL and LCL
Medial and lateral patella retinaculum
What is the major posterior extracapsular ligament of the knee?
Oblique popliteal ligament
What ligament connects the oblique popliteal with the fibula?
Arcuate ligament
What muscle runs from the tibia to the lateral femur?
Popliteus
What is the purpose of the popliteus muscle?
Locking mechanism
What are the two parts of the cranium?
Calvaria (cranial vault) and cranial base
What are the three cranial sutures on top of the cranium?
Coronal, sagittal, and lambdoid
What is the foramen on the parietal bone near the sagittal and labdoid sutures?
Parietal Emmisary foramen
Which fontanel closes at three months?
Sphenoidal fontanel
Which fontanel closes at two months?
Occipital fontanel
Which fontanel closes at 2 years?
Frontal fontanel
What are the three parts of the frontal bone?
Squamous, nasal, and orbital
What is the arch of the frontal bone above the orbit
Supercilliary arch
What is the attachment site for the dura mater in the frontal bone?
Frontal crest
What three things does the frontal crest lead into?
The foramen cecum, then crista galli and cribiform plate
“Raccoon eyes” is associated with skull fractures 85% of which are localized to the:
Anterior cranial fossa
What do olfactory nerves pass through?
Cribiform plate
What are the sites for muscle attachment on the occipital bone?
Superior and inferior nuchal lines
Anterior to the foramen magnum is an attachment point called the:
Pharyngeal tubercle
A sign of basilar and temporal bone fractures due to rupture of the mastoid emissary vein is:
Mastoid ecchymosis or “Battle’s Sign”
The “H” shaped joining of frontal, sphenoid, temporal, and parietal bones is called the:
Pterion
What artery is deep to the pterion (weakest part of the skull)
Middle meningeal artery
Fractures to the medial cranial fossal will cause:
Bleeding from the are or hemotympanum
What are the three layers of flat bones?
Outer table, diploe, and inner table
What are the layers of the scalp?
Skin Connective tissue (dense) Aponeurosis Loose areolar CT Pericranium
Why is it hard to stop bleeding from the scalp?
Fibrous septa in the CT prevent vessel contraction
What is the connection of the occipitofrontalis muscle?
Galea aponeurosis
What is cephalohematoma?
Blood in the subperiosteal space, benign, limited to one bone
What are the three membranous layers over the brain
Dura mater
Arachnoid mater
Pia mater
Which space contains CSF?
Subarachnoid space
What are the two layers of the dura mater?
Periosteal layer
Meningeal layer
What are the two dural septa?
What sections do they split the brain into?
Falx cerebri (left and right) Tentorium cerebelli (cerebellum and occipital lobe)
What are the triangular joining spaces of the dural septa?
Dural sinuses
What are the brains four main dural sinuses?
Superior and inferior sagittal, cavernosus, and transverse
Are subdural hematomas usually acute or chronic?
Chronic
On which side of the leg does the superficial fibulae nerve run?
Lateral
What are the contents of the adductor canal?
Femoral artery and vein, saphenous nerve, nerve to vastus medialis
What nerve passes behind the head and around the neck of the fibula?
Common fibular
Which artery enters the anterior compartments of the leg by passing through the upper part of the interosseus membrane between the fibula and tibia?
Anterior tibial
What muscle inverts the foot?
Tibialis posterior
The integrity of which nerves is tested using the patellar reflex?
L2-L4
What are the infrahyoid muscles?
Thyrohyoid
Sternohyoid
Omohyoid
Sternothyroid
What are 3/4 infrahyoid muscles innervated by? Which one has different innervation?
Ansa cervicalis
Thyrohyoid
What are the roots of ansa cervicalis?
C1-C3
What is the thyrohyoid innervated by?
C1 traveling with hypoglossal
Where do cranial nerves 9, 10, and 11 leave the skull?
Jugular foramen
What are the three branches of the trigeminal nerve (CN V)
V1- opthalmic
V2- maxillary
V3- mandibular
Where do the trigeminal nerve branches leave the skull?
V1- Superior orbital fissure
V2- Foramen rotundum
V3- Foramen ovale
Where does cranial nerve 12 leave the skull?
Hypogossal foramen
List the cranial nerves
I- Olfactory II- Opthalmic III- Oculomotor IV- Trochlear V- Trigeminal VI- Abducens VII- Fascial VIII- Vestibulocochlear IX- Glossopharyngeal X- Vagus Xi- Accessory XII- Hypoglossal
What innervates the sternocleidomastoid muscle? What else does it innervate?
CN XI- accessory nerve
Trapezius
CN VII innervates which neck muscles?
Stylohyoid and posterior belly of digastric
The anterior belly of the digastric and the myelohyoid are innervated by which nerve?
Nerve to myelohyoid, a branch off Trigeminal (CN V)
Where does the superior thyroid artery arise from?
External carotid a.
Where does the inferior thyroid artery arise from?
Subclavian a. (thyrocervical trunk)
10% of people have an accessory thyroid artery called:
Thyroidea ima
Superior and middle thyroid veins drain into the:
Internal jugular v.
Inferior thyroid veins drain into the:
Left brachiocephalic v.
What atructures are contained within the carotid sheath?
Common carotid artery
External jugular vein
Vagus nerve (CN X)
The recurrent laryngeal nerves are branches of the:
Vagus nerve
What are the branches of the subclavian artery?
Vertebral Internal Thoracic Thyrocervical trunk Costocervical trunk Dorsal Scapular
What are the branches of the thyrocervical trunk?
Inferior thyroid
Suprascapular
Ascending cervical
Transverse cervical
A disorder in which the sublavian artery is blocked proximal to the vertebral artery, resulting in use of anastimoses through the opposite vertebral artery and basilar artery. Symptoms include vertigo, visual dysfunction, and ispilateral upper extremity symptoms.
Subclavian steal syndrome
What is the continuation of prevertebral fascia over the top of the lung?
Sibson’s fascia (suprapleural membrane)
What are the six branches of the external carotid artery?
Superior thyroid, Lingual, Facial
Occipital, Posterior auricular,
Ascending pharyngeal
What does the external carotid artery turn into?
Maxillary and superficial temporal arteries
What is the purpose f the carotid body?
Chemoreceptors (blood composition)
What nerve supplies the carotid body?
Glossopharyngeal (CN IX) (Twins with vagus, CN X)
What is the purpose of the carotid sinus?
Baroreceptors (blood pressure)
What are the cervical branches of the vagus nerve?
Pharyngeal
Superior layngeal
Cervical cardiac
What are the first four cranial nerves?
Olfactory
Optic
Oculomotor
Trochlear
What are cranial nerves 5-8?
Trigeminal
Abducens
Vestibulocochlear
Glossopharyngeal
What are cranial nerves 9-12?
Vagus
Spinal accessory
Hypoglossal
What are the names of the four neonatal fontanels?
Frontal
Sphenoidal
Mastoid
Occipital
Which fontanel closes earliest?
Occipital (2 months)
Which fontanel closes latest?
Frontal (2 years)
What condition is associated with fracture of the skull base, 85% in the anterior cranial fossa?
“Raccoon eyes”
Periorbital ecchymosis
Leak of CSF through the nose is a result of traumatic detatchment of:
Dura mater from fronal crest
What foramen lies at the bottom of the frontal crest?
Foramen cecum
Where do the olfactory nerves enter the skull?
Cribiform plate
___ is an indication of basilar and temporal bone fractures?
Mastoid ecchymosis or “Battle sign”
The bruising seen in the battle sign is a result of rupture of which vein?
Mastoid emissary vein
The cranium is made up of the:
Cranial vault (calvaria) and base
What are the contents of the cranial cavity?
Brain, meninges, CSF
What suture runs between the parietal bones?
Sagittal
When do the sphenoidal fontanels close?
3 months
What can be indicated by palpating the newborn fontanels?
Intracranial pressure
Accumulation of excessive CSF is called:
Hydrocephalus
What produces CSF?
The choroid plexuses in the pia mater
Hydrocephalus may be caused by lack of CSF absorption back to the venous dural sinuses due to underdevelopment of the:
Arachnoid villi
Hydrocephalus may be caused by CSF accumulation in the ventricles due to obstruction of CSF flow through the:
Cerebral aquaduct
From which bone is the cribiform plate made?
Ethmoid
What is the weakest part of the skull? What vein lies behind it?
Pterior
Middle meningeal vein
Fracture of the pyramid of the temporal bone, parts of the sphenoid bone, and the medial cranial fossa may lead to:
Hemotympanum or bleeding from the ear
What is the name of the aponeurosis in the scalp?
Galea aponeurotica
What type of cyst can be found in the first layer of the scalp?
Sebaceous (pilar)
Which layer is the “danger zone of the scalp”? Why?
LCT, because pus/blood from subarachnoid space can enter eyelids and root of nose, or into the cranial cavity via emissary veins (through parietal foremena)
Bleeding in which scalp space is limited to one bone by sutural ligaments?
Pericranium/ subperiosteal potential space (cephalohematoma)
What are the meninges? What are the layers?
Three membranous CT layers which surround the brain.
Dura mater, arachnoid mater, and pia mater
What is the only pain sensitive intracranial structure?
Dura mater
What are the two layers of the dura mater?
Periosteal and meningeal
What are the two partitioning reflections of dura mater?
Falx cerebri and tentorium cerebelli
The sinuses which drain almost all of the blood from the brain are:
Sagittal
Straight
Transverse (X2)
Sigmoid (X2)
What vein collects the blood drained by the dural sinuses?
Internal jugular
Which veins connect the venous sinuses with the superficial veins of the scalp?
Emissary veins
What veins cause a subdural hematoma?
Superficial cerebral veins
Which hematoma can surround part of the brain, unbound?
Subdural hematoma
Swelling of the ventricles of the brain is a hallmark for:
Hydrocephalus
Shifting of brain tissue as seen in a subdural hematoma is called:
Herniation
What vessels supply the bones of the calvaria?
Meningeal arteries
The middle meningeal artery enters the middle cranial fossa through which foramen?
Spinosum
Which hematoma appears biconvex on CT/ MRI?
Epidural hematoma
Which time of hematoma is chronic?
Subdural
Epidural hematoma is caused by rupture of what vessels?
Meningeal arteries
Preganglionic fibers from the Edinger Westphal nucleus in the midbrain travel on CN __ to the ___ ganglion
CN III, Ciliary ganglion
Preganglionic fibers from the superior salivatory nucleus in the pons travel on CN __ to the ___ ganglion AND the ____
CN VII, pterygopalatine, submandibular
Preganglionic fibers from the inferior salivatory nucleus travel on CN __ to the ___ ganglion
CN IX, otic ganglion
Preganglionic fibers from the dorsal nucleus of vagus in the midbrain travel on CN __ to the ___ ganglion
X, intramural ganglia of target organs
Postganglionic fibers from the ciliary ganglion are called ___, and they enter the eyeball and supply the____
Short ciliary nerves, intraocular muscles
The nerve that runs from the superior salivatory nucleus via CN VII to the pterygopalatine ganglion is called the:
Greater petrosal
Postganglionic fibers from the pterygopalatine ganglion supply the mucosa glands of the: (4)
Nasal cavities
Oral cavities
Paranasal sinuses
Lacrimal gland
The nerve that runs from the superior salivatory nucleus via CN VII to the submandibular ganglion is called the:
Chorda tympani
The postganglionic fibers from the submandibular ganglion supply the:
Submandibular and sublingual glands
The nerve connecting the inferior salivatory nucleus and the otic ganglion using CN IX is called the:
Lesser petrosal nerve
The postganglionic fibers of the lesser petrosal nerve supply the:
Parotid gland
In a lesion of the ___ nerve, there will be lack of pupillary reflex, ptosis due to lack of innervation of lev. palpebrae superioris, and one eye will move down and out, since only the superior oblique and lateral rectus muscles remain innervated
Oculomotor
Which is the smallest cranial nerve which arrises from the posterior surface of the brainstem?
Trochlear nerve
Paralysis of which CN will result in diplopia when looking down? When looking outwards and far away?
Trochlear, Abducens
What are the three divisions of the trigeminal nerve?
Opthalmic
Maxillary
Mandibular
What are the three nerve branches of the V1
Nasociliary, frontal, lacrimal
Where does V1 exit the skull?
Superior orbital fissure
Many branches of V2 carry fibers from the ___ ganglion to the mucous glands of nasal/oral cavities and lacrimal gland
Pterygopalatine
V2 carries taste fibers from palate via ____ nerves to the nerve of the pterygoid canal and the greater petrosal nerve to the geniculate ganglion of the facial nerve
Palatine
V3, unlike V1 nd V2, carries ___ fibers
Motor
Two parasympathetic ganglia associated with V3 are the:
Otic and submandibular ganglia, both concerned with innervation of salivary glands
What disorder causing sharp facial pain is associated with V2 and V3
Tic Douloureux or trigeminal neuralgia
CN V can be evaluated by:
Corneal reflex
Where is the nucleus of CN abducens?
In pons near median plane
When this nerve is paralyzed, the eye will be drawn medially due to unopposed action of CN III and medial rectus, resulting in diplopia.
Abducens
What does the facial nerve innervate?
Muscles of facial expression, stapedius, stylohyoid, and posterior belly digastric
What nerve carries sensory fibers from the palate and anterior 2/3 of the tongue?
Facial
What is the sensory ganglion of the facial nerve?
Geniculate ganglion
Through which foramen does the facial nerve leave the skull?
Stylohyoid
What gland does the facial nerve enter before branching into it’s terminal branches?
Parotid gland
What are the five terminal branches of the facial nerve?
Temporal Zygomatic Buccal Mandibular (marginal) Cervical
Lesion of which nerve may result in tinnitis?
Vestibulocochlear
Lesion of which nerve may result in Bell’s palsy?
Facial
The glossopharyngeal nerve (CN ___) provides ___ fibers for one pharyngeal muscle
IX, somatic motor fibers
The glossopharyngeal nerve provides ____ fibers for the parotid gland, taste and generl sensory for the posterior 1/3 of the tongue, tonsil, auditory tube, middle ear, and oropharynx
Presynaptic parasympathetic fibers
The glossopharyngeal nerve provides ____ fibers for the carotid body and sinus
Special sensory fibers
Just below the base of the skull, the glossopharyngeal nerve bears two ganglia, the:
SUperior (jugular) and inferior (petrosal)
The five branches of the glossopharyngeal nerve are:
Tympanic Carotid sinus Pharyngeal Nerve to stylopharyngeus Lingual
The six branches of the vagus nerve are:
Auricular Pharyngeal Superior laryngeal Superior/Inferior cervical cardiac Recurrent laryngeal
The cranial rootlets o the accessory nerve arise from which nucleus?
Nucleus ambiguus
The accessory nerve has two rootlets, what are they?
Cranial and spinal
If accessory nerve is damaged by skull fracture or severe lymph node enlargement, a twisting of the neck called ____ may occur
Torticollis
Which CN innervates all tongue muscles except for styloglossus?
Hypoglossal nerve
Deviation of the uvula is a sign of lesion to which cranial nerve?
Vagus
Shoulder drooping (sternocleidomastoid and trapezius) is a sign of damage to which CN?
Accessory spinal (CN XI)
What veins merge to form the external jugular?
Retromandibular and posterior auricular
What nerve runs with the external jugular vein?
Great auricular
What are the roots of ansa cervicalis? What does it supply?
C1-C3
Infrahyoid muscles
