Lower limb Flashcards
12713 – At the hip joint
1: the obturator internus produces lateral rotation
2: the gluteus medius produces abduction
3: the gluteus minimus produces medial rotation
4: the obturator externus produces medial rotation
TTTF
Any muscle passing obliquely or transversely across the back of the hip joint and behind the vertical axis around which the femoral head rotates must act as a lateral rotator of the extended thigh.
Gluteus maximus is the most powerful lateral rotator. The others are more active as stabilisers of the hip joint but obturator internus together with the gluteus medius, piriformis, gemelli, obturator externus and quadratus femoris are lateral rotators (A true). Any muscle whose line of pull passes across the front of the hip joint and thus anterior to the vertical axis around which the femoral head rotates must act as a medial rotator of the extended thigh. The anterior portions of both gluteus minimus (C true) and gluteus medius can thus act as medial rotators as do the psoas major and illiacus. The obturator externus passes behind the hip joint, and although mainly a stabiliser of the hip joint, is therefore also a lateral rotator of the extended thigh (D false). Abduction is produced by the gluteus medius and gluteus minimus (B true).
22018 – The gluteus maximus muscle
1: is attached to the intertrochanteric line of the femur
2: is attached to the iliotibial tract
3: is supplied by fibres from L4, L5 and S1
4: is an extensor of the trunk on the lower limb
FTFT
Last PAGE: 145, 146
Gluteus maximus
Arises: outer surface of ilium behind posterior gluteal line, and posterior third of iliac crest, lumbar fascia, lateral mass of sacrum, sacrotuberous ligament, and coccyx.
inerts: Deeperst quarter into gluteal tuberosity of femur, remaining 3/4 into the iliotibial tract (anterior surface of lateral condyle of tibia.
Action: extends and latearlly rotates hip. Maintains knee extended via iliotibial tract
Nerve: inferior gluteal L5,S1,S2
Largest muscle in the body
19198 – The superior gluteal nerve
A. has a cutaneous distribution to the skin of the buttock
B. gives off deep and superficial branches
C. supplies the tensor fascia lata
D. supplies the gluteus maximus
E. contains fibres from the second sacral spinal segment
C
Last 8th ed. PAGE: 164, 399
L4, L5, S1.
Passes above piriformis through greater sciatic foramen
19312 – The ossification centre of the femoral head appears
A. at the eighth week of foetal life
B. by the sixth post-natal week
C. in the first year of life
D. at 2 years of age
E. at 3 years of age
C
Last 8th ed. PAGE: 224
23474 – The femoral canal
1: at its proximal end is medial to the femoral vein
2: contains the femoral branch of the genitofemoral nerve
3: at its proximal end is posterior to the inguinal ligament
4: is the lateral compartment of the femoral sheath
TFTF
Last PAGE: 138
NAV - space
Femoral branch of genitofemoral nerve is in the femoral triangle but not in canal
all of it is posterior to inguinal ligament,
it is medial in the femoral sheath
21193 – The femoral triangle
1: has a floor formed by the iliacus muscle, the psoas major tendon, the pectineus muscle and the adductor longus muscle
2: is bounded below and medially by the adductor brevis muscle
3: is roofed over by the fascia lata of the thigh
4: contains the obturator nerve
TFTF
Last 8th ed. PAGE: 152-4.
Boundaries:
- inguingal ligamnet,
- Medial: medial border of adductor longus
- lateral: medial border of sartorius
- floor - pectineus and adductor longus medially, psoas major and iliacus latearlly
contents of the femoral triangle
N
- Lateral cutaneous nerve of the thigh.
- nerve to pectineus arising from the femoral nerve just above inguinal ligament. passes behind the femoral sheath
- Femoral nerve
Femoral sheath:
- NAVEL
Femoral branch of the genitofemoral n, femoral nerve , artery, vein, empty space, lymphatics - deep inguingal lymph nodes - drains the clitoris or glands penis.
7834 – The femoral vein in the femoral triangle
1: is medial to the femoral artery
2: is lateral to the femoral canal
3: directly receives the great (long) saphenous vein
4: directly receives the profunda femoris vein
TTTT
Last 10th ed, Ch 3
22529 – Boundaries of the femoral ring include
1: inguinal ligament
2: femoral vein
3: lacunar ligament
4: pectineal ligament
TTTT
Last PAGE: 138
The superior opening of the femoral canal under the inguinal ligament is termed the femoral ring
946 – In femoral hernia, the hernial sac
1: passes behind the inguinal ligament.
2: Passes medial to the femoral vein.
3: Passes anterior to the superior pubic ramus.
4: Is covered by the fascias of the femoral septum and the cribriform fascia.
5: Contains a large quantity of fat.
TTTTT
The sac of a femoral hernia passes behind the inguinal ligament (1 true) into the femoral canal, which lies medial to the femoral vein and anterior to the superior pubic ramus. (2 & 3 true). The sac enters the femoral canal through its upper opening -the femoral ring. This is normally closed by the femoral septum, a fusion of iliopectineal fascia behind and transversalis fascia anteriorly. The sac, covered by intraperitoneal fat and femoral septum fascia, leaves the femoral canal to enter the subcutaneous tissues of thigh and groin,
by passing anteriorly through the fossa ovalis and its overlying cribriform fascia. (4 true). The sac of a femoral hernia thus contains several fascial layers separated from each other by fat. A large portion of the sac is fatty (5 true) which can make the cough impulse of a femoral hernia less obvious.
21033 – S. A femoral hernia can present deep to the membranous layer of superficial fascia of the abdominal wall (scarpa’s fascia) BECAUSE R. Scarpa’s fascia inserts into the deep surface of the inguinal ligament
both S and R and false
Last Page: 133
934 – Femoral hernia is
1: More common in female than in male patients.
2: More common than inguinal hernia in female patients.
3: Able to be controlled by the wearing of a hernia truss.
4: Classically associated with strangulation bowel obstruction of Richter type.
5: More prone to recurrence after surgery than is inguinal hernia.
TFFTF
Femoral hernia is more common in females than in males (1 true). You would need to go back further to find the records of 100 femoral hernia repairs, because femoral hernias are much less common than are inguinal hernias. But there would be a majority of females in your group. The femoral ring and canal are wider in females than males, in keeping with the wider female pelvis.
Inguinal hernias outnumber femoral in women as well as in men (2 false). Thus if you identify a groin hernia and you cannot be sure of the clinical diagnosis in a male, the odds on it being inguinal are quite high. In a woman under the same circumstances the hernia is also more likely to be inguinal, but the odds will not be so great. For most hernias, a truss is not a reliable method of control. The hernia must be reducible and the truss needs to control the defect and prevent the hernia escaping. If the hernia does protrude while a truss is worn, the effectiveness of the truss is lost and the risk of
strangulation increased. A truss might be occasionally helpful in an infirm patient when the mouth of the hernial sac is wide, the hernia is easily reducible and the risk of strangulation considered low.
Femoral hernias have a small neck and a tortuous sac pathway and are particularly unsuited to truss use (3 false). Response 4 is true and 5 false (see X1).
7759 – Division of the lumbo-sacral trunk would cause
1: loss of skin sensibility in the great toe
2: weakness of peroneus longus
3: weakness of extensor hallucis longus
4: weakness of abductor hallucis
TTTF
Last 10th ed, Ch 1 and Ch 5.
Lumbosacral trunk = anterior segment of 4th and 5th lumbar nerves. Forms the sciatic nerve. Would cause weakness in fibular (peroneal) nerve.
Abductor hallucis - innervated by medial plantar nerve, branch of tibial n (L5, S1) hence not affected
19617 – The ventral primary ramus of S1
A. contributes to the pudendal nerve
B. is distributed to skin on the back of the thigh
C. is distributed to flexors of the hip
D. is distributed to evertors of the foot
E. contributes to the lumbo-sacral trunk
D
Last PAGE: 29
21883 – The sacral plexus
1: supplies obturator externus muscle
2: is formed by ventral rami of L4, L5, S1, S2,S3 and S4 spinal nerves
3: receives the lumbosacral trunk
4: lies in front of the piriformis muscle
FTTT
Last (8) PAGE: 160, 416
Obturator externus is supplies by posterior division of obturator nerve L3,4
Sacral plexus lies on piriformis
L4,5, S1,2,3,4 from lumbosacral trunk L4, 5 and anterior primary rami from S1-4 to definitve nerves
All six branches leaving sacral roots begin with p
Piriformis (nerve to) S1,2
Posterior femoral cutaneous
- S1,2,3 , exits greater sciatic foramen
Perforating cutaneous
- S2,3 exits greater sciatic foramen
Pudendal
- S2,3,4 exits lessor sciatic foramen
pelvic splanchnic
- S2,3,4 (parasympathetic)
Perineal branch of S4
- Supplies levator ani
Others are superior and inferior gluteal which are both L4,5,S1
23134 – The femoral nerve
1: supplies skin on the medial side of the leg
2: enters the thigh anterior to the iliopsoas fascia
3: supplies the psoas major muscle
4: supplies the pectineus muscle
TFFT
Last PAGE: 139, 165
1: Anterior femoral cutaneous does most of the medial distal thigh and saphenous nerve (branch of femoral) does medial leg?
2: lies in the groove between psoas and iliacus /lies on the iliacus
3: psoas major is supplied by anterior primary rami of L1,2
2324 – The femoral nerve
1: is formed in the substance of psoas major
2: emerges on the lateral side of the psoas muscle
3: lies on the iliacus muscle beneath the inguinal ligament
4: is formed from the posterior divisions of the ventral rami of L 2, 3, 4
TTTT
Last (8) PAGE: 362
13956 – The femoral nerve is most likely to
A. arise from the anterior divisions of the ventral rami of L2, L3, L4
B. supply the gracilis muscle
C. lie medial to the femoral artery under the inguinal ligament
D. supply sensation to skin on the medial malleolus
E. supply sensation to the skin over the central border of the foot via the sural nerve
D
Refer to Last, 10th Ed, page 157
A - posterior divisions of ventral rami (ant div = obturator n)
B - Gracilis is supplied by anterior division of obturator n L2,3
C - lies lateral to femoral artery (NAVY!)
D - via saphenous nerve
12718 – The femoral nerve supplies the
1: pectineus
2: tensor fasciae latae
3: psoas major
4: gracilis
TFFF
The femoral nerve in the thigh branches into superficial and deep branches and supplies pectineus (A true), sartorius, rectus femoris and the vasti.
The gracilis is supplied by the obturator nerve as are the adductors (D false). Psoas is supplied segmentally from the lumbar plexus L1,2 (C false). Tensor fasciae latae is supplied by the superior gluteal nerve which ends in it (L4,5) (B false).
20199 – S. The femoral nerve remains outside the femoral sheath BECAUSE R. the femoral nerve lies behind the fascia iliaca
S is true, R is true and a valid explanation of S
Last PAGE: 138
20307 – S. The femoral nerve supplies muscles in the extensor compartment of the thigh BECAUSE R. the femoral nerve is derived from
posterior divisions of anterior primary rami
S is true, R is true and a valid explanation of S
Last 8th ed. PAGE: 156
24109 – The sciatic nerve
1: gives a branch to adductor magnus
2: supplies extensors of the hip
3: supplies flexors of the knee
4: supplies skin on the posterior aspect of the thigh
TTTF
Last PAGE: 153, 154
4 - posterior femoral curaneous nerve of the thigh (nerve from sacral plexus)
21333 – The sciatic nerve
1: supplies all three hamstrings and ischial fibres of adductor magnus
2: is a direct posterior relation of the hip capsule
3: supplies quadratus femoris and obturator internus
4: is supplied with blood by a branch of the inferior gluteal artery
TFFT
Last 8th ed. PAGE: 167, 418
3 - quad fem supplied by nerve to quadratus femoris (L5, S1), obturator internus supplied by nerve to obturator internus (L5, S1,2)
19683 – Division of the sciatic nerve would result in loss of sensation
A. on all of the thigh, leg and foot
B. on the back of the thigh and calf, and on the sole of the foot
C. on all of the leg and foot
D. on the lateral side of the calf and most of the foot
E. over most of the sole of the foot alone
D
Last PAGE: 154
Ant thigh - femoral
post thigh - post femoral cutaneous
medial leg - saphenous n
19018 – As it passes down the thigh, the sciatic nerve is crossed superficially from medial to lateral by
A. adductor magnus
B. long head of biceps femoris
C. semimembranosus
D. quadratus femoris
E. short head of biceps femoris
B
Last PAGE: 154
14132 – With respect to the nerve supply of the lower limb
1: all interosseous muscles of the foot are supplied by the medial plantar nerve
2: the weight bearing area of the heel is supplied by the medial calcaneal nerve
3: extension of the knee is associated with spinal segments L4/5
4: sensation in the groin is associated with spinal segment L1
FTFT
Refer to Last, 10th Ed, page 13-17, 148-149
1 - one interossei (first ?) supplied by lateral plantar)
2.-
3 knee ext L3/4
4 - sensation in groin L1
19252 – Which of the following muscles does not arise from the ischial tuberosity?
A. semimembranosus
B. adductor magnus
C. obturator externus
D. long head of biceps femoris
E. semitendinosus
C
Last PAGE: 143, 152
All of hamstring arise from ischial tuberosity!
20337 – S. Fracture of the femoral neck proximal to the capsular attachment may cause aseptic necrosis BECAUSE R. the head and neck of the femur receive their blood supply mainly through the subcapsular retinacular arteries
S is true, R is true and a valid explanation of S
Last 8th ed. PAGE: 167
14957 – The deep fascia of the thigh
1: receives the insertion of the whole of the tensor fasciae latae muscle
2: splits to enclose the gluteus maximus muscle
3: is attached to the inguinal ligament
4: receives the insertion of the whole of the gluteus maximus muscle
TTTF
Refer to Last, 10th Ed, page 111-112
deepest quarter into gluteal tuberosity, remaining three quarters into iliotibial tract ( anterior surface of lateral condyle of tibia). only receives 3/4 of it.
21188 – The femoral artery
1: is deep to the adductor brevis muscle
2: lies anterior to the tendon of psoas major
3: gives only a profunda branch in the femoral triangle
4: is posterior to the femoral vein in the upper part of the adductor (subsartorial) canal
FTFF
Last 8th ed. PAGE: 154-5
Lies on the tendon of psoas major and is separated from pectineus and adductor longus by femoral vein,
femoral vein begins to lie progressively more posterior to the artery within the femoral triangle. as it enters the adductor canal it lies on the adductor longus and then magnus.
saphernous nerve passes anteriorally from lateral to medially.
Adductor canal
- groove in anterior thigh extending from apex of femoral triangle to hiatus in adductor magnus
- borders
lateral - vastus med; med - add long superiorly and add mag inferiorly. roof = sartorius and subsartorial plexus.
in popliteal fossa popliteal artery is deepest structure
22864 – The cruciate anastomosis is formed from
1: the transverse branch of the medial circumflex artery
2: the descending branch of the inferior gluteal artery
3: the ascending branch of the first perforating artery
4: the ascending branch of the lateral circumflex artery
TTTF
Last 8th ed. PAGE: 166
19192 – The pectineus muscle
A. is covered on its deep surface by the fascia lata
B. is inserted along the spiral line of the femur
C. lies anterior to the anterior division of the obturator nerve
D. is attached to the pubic tubercle
E. is supplied by the posterior division of the femoral nerve
C
Last 8th ed. PAGE: 154
arises - pectineal line of pubis and area of sup pub ramus
inserts - vertical line between spiral line and gluteal crest below lesser trochanter
action - flexes and adduct hip
nerve - ant div of femoral (not post). occ twig from obturator.
relations
- posterior is adductor magnus, brevis and obturator externus. and anterior branch of obturator nerve.
22259 – At the distal end of the femur
1: the popliteus muscle is attached to the anterior end of a groove on the lateral condyle of the femur
2: the lateral condyle projects further forwards than the medial condyle
3: the anterior cruciate ligament is attached to the lateral condyle
4: growth stops before the cessation of growth at the proximal end
TTTF
Last (Page 157,200) Green Book (K2, K3)
20703 – S. The short head of biceps femoris is supplied from segments L5 and S1 BECAUSE R. the short head of biceps femoris is supplied by the tibial division of the sciatic nerve
S is true and R is false
Last 8th ed. PAGE: 170
Long head supplied by tibial sciatic
short head supplied by common fibular portion of sciatic (both L5,S1,2)
7664 – The adductor muscles of the thigh are arranged anteroposteriorly in
the order
A. longus, magnus, brevis
B. brevis, longus, magnus
C. longus, brevis, magnus
D. brevis, magnus, longus
E. none of the above
C
Last 10th ed, Ch 3
