Lower Limb Flashcards
(5.2) A patient’s right ventral primary ramus of L4 has been transected. Which problem would be seen during physical examination?
The ventral ramus of L4 contains both sensory and motor nerve fibers. L4 dermatome supplies the medial aspect of the leg and foot.
Loss of the Achilles tendon reflex relates primary to an S1 deficit.
(5.3) A man injured his right lower limb where his superior gluteal nerve was injured. He later exhibits a waddling gait and a positive Trendelenburg sign. What physical finding would be seen in this patient?
The left side of the pelvis droops or sags when he attempts to stand with his weight supported just by the right lower limb
(5.4) A man fractured both his tibia and fibula. The patient has a foot drop, but normal eversion. Which nerve is injured?
The deep fibular (peroneal) nerve is responsible for innervating the muscles of the anterior compartment of the leg, which are responsible for toe extension, foot dorsiflexion and inversion. Injury to this nerve will result in foot drop and also loss of sensation between the first and second toes.
(5.5) A man has a painful lump on the proximal medial aspect of his thigh. Examination reveals the patient has a herniation of abdominal viscera beneath the inguinal ligament into the thigh. Through which opening will a hernia of this type initially pass to extend from the abdomen into the thigh?
The femoral ring is the abdominal opening of the femoral canal. A femoral hernia passes through the femoral ring into the femoral canal deep and inferior to the inguinal ligament.
(5.6) A man has a fracture involving the talocrural (tibiotalar) joint. Which movements are the major ones to be affected?
The talocrural (tibiotalar) joint is a hinge-type joint between the tibia and talus. It permits dorsiflexion and plantar flexion, and fracture of this joint would affect these movements.
(5.7) The key landmark in the gluteal region, relied upon in surgical explorations of this area, is provided by which structure?
The piriformis muscle arises from the pelvic surface of the sacrum, passes through the greater sciatic notch, and inserts at the greater trochanter. It is considered the anatomical key to gluteal anatomy. The gluteus medius lies posterior to the piriformis. The sciatic nerve emerges from the greater sciatic foramen, normally through the infrapiriformic space.
(5.8) A boy received a superficial cut on the lateral side of his foot. Which group of nodes will first receive lymph from the infected area?
The popliteal lymph nodes are the first to receive lymph from the foot. These nodes will then drain into the deep inguinal nodes and then to the external iliac nodes.
(5.9) A man has a Baker’s cyst in the popliteal fossa compressing the tibial nerve. Which movement will be affected?
The tibial nerve is responsible for innervating the posterior compartment of the leg. These muscles are responsible for knee flexion, plantar flexion and intrisic muscles of the foot.
(5.11) A patient complains of pain and general lack of normal sensation on the medial surface of the right leg and foot. Which nerve was injured?
The saphenous nerve is responsible for cutaneous innervations on the medial surface of the leg and the medial side of the foot.
The lateral sural nerve is a cutaneous nerve that arises from the junction of branches from the common fibular (peroneal) nerve and tibial nerve and innervates the skin on the posterior aspect of the leg and lateral side of the foot.
(5.12) A man has an inversion sprain of his ankle. Which ligament is most likely injured?
The calcaneofibular ligament is injured during inversions. The anterior talofibular ligament also serves to stabilize the foot and prevent inversion injuries.
(5.13) A woman has a thrombotic occlusion of the femoral artery in the prox. part of the adductor canal. Which artery will most likely provide blood supply to the leg through the genicular anastomosis?
The lateral circumflex femoral artery arises from the deep femoral artery of the thigh and sends a descending branch down the length of the femur to anastomose with the superior medial genicular artery and the superior lateral genicular artery.
The medial circumflex femoral artery is responsible for supplying blood to the head and neck of the femur. The first perforating artery sends an ascending branch that anastomoses with the medial circumflex femoral and the inf. gluteal artery.
(5.15) A man has weakened adductors of the right thigh. Which nerve is being compressed that resulted in this?
The obturator nerve arises from the lumbar plexus and innervates the medial compartment of the thigh (aka adductor compartment).
The femoral nerve innervates muscles of the ant. compartment of the thigh that are responsible for hip flexion and leg extension.
The tibial nerve innervates the muscles of the post. compartment of the thigh and leg, which are responsible for extension of the hip, flexion of the leg and plantar flexion of the foot.
(5.16) A boy has numbess of the dorsum of his right food and inability to dorsiflex and evert his foot. Which is the most probably site of the nerve compression that resulted in these symptoms?
The common fibular (peroneal) nerve winds aroud the neck of the fibula before dividing into superficial and deep branches that go on to innervate the lateral and anterior compartments of the leg, respectively. These compartments are responsible for dorsiflexion and eversion of the foot.
The tibial nerve lies superficially in the popliteal fossa and innervates the post. compartment of the leg, which allows for plantar flexion and inversion.
(5.17) A man has difficulty rising to a standing position from a seated position. Which muscle is injured?
The gluteus maximus is innervated by the inf. gluteal nerve and is the primary muscle that extends the flexed hip and is used to rise from a seated position.
The gluteus minimus is innervated by the sup. gluteal nerve and is responsible for abduction of the thigh.
(5.18) A man has numbness along the adjacent sides of the first and second toes. Which nerve is injured?
The medial branch of the deep fibular (peroneal) nerve accompanies the dorsalis pedis artery and innervates the skin between the contiguous sides of the first and second toes.
