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Moores Blue Boxes > Lower Limb > Flashcards

Lower Limb Flashcards

1
Q

What are the most common lower leg injuries

A

Knee, leg and foot

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2
Q

How do most lower leg injuries occur

A

Acute trauma during contact sports such as hockey and foot ball and from overuse during endurance sports

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3
Q

Why are adolescents more vulnerable to sport related lower limb injuries

A

Demands of sports on their maturing MSK systems

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4
Q

The cartilaginous models of the bones in the developing lower limbs are transformed into bone by ___ ___

A

Endochondral ossification

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5
Q

When does endochondral ossification of lower limb complete

A

Early adulthood

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6
Q

Epiphyseal plates

A

Discs of hyaline cartilage between the metaphysics and epiphysis of a mature long bone that permit the bone to grow long

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7
Q

During a growth spurt, do muscles of bones grow faster

A

Bone

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8
Q

Osteochondrosis

A

Irritation and injury of epiphyseal plates and developing bones from combined stress on the epiphysesal plates resulting from physical activity and rapid growth

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9
Q

Pelvic fractures

A

Hip bone fracture

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10
Q

Hip fracture

A

Femoral Head, neck or trochanter

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11
Q

How may you get an avulsion fracture of the hip bone

A

Sports that require sudden acceleration or deceleration forces, such as sprinting or kicking a footblall, soccer, hurdle jumping, basketball and martial arts

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12
Q

What is an avulsion fracture

A

A small part of bone with a pierce of a tendon or ligament attached is avulsed away

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13
Q

Where do avulsion fractures typically occur

A

Apophyses

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14
Q

Coxa vara

A

When angle on inclination is decreased between the long axis of the femoral neck and the femoral shaft

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15
Q

Coxa Volga

A

When angle of inclination between long axis of femoral neck and femoral short is increased

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16
Q

Valga and virus describe what

A

Joint deformed

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17
Q

Coxa vara causes a mild ___ of the lower limb and limits passive abduction of the hip

A

Shortens

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18
Q

Why in older children and adolescents , may the epiphysis of the femoral head slip away fromt he femoral neck

A

Weak epiphyseal plate

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19
Q

What may cause dislocation of epiphysis of femoral head

A

Acute trauma or repetitive microtraumas that place increased shearing stress on the epiphysis, especially with abduction and lateral rotation of the thigh

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20
Q

The epiphysis often dislocates slowly resulting in a progressive __ ___

A

Coxa vara

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21
Q

Common initial symptom of dislocated epiphysis of femoral head

A

Hip discomfort that may be referred to the knee

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22
Q

How do you confirm a diagnosis of a dislocated epiphysis of the head of the femur

A

Radiographically examination of the superior end of the femur

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23
Q

Despite its large size and strength, the femur is commonly ___

A

Fractured

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24
Q

Why is the neck of the femur the most frequently fractured part

A

Narrowest and weakest and lies at a marked angle to the line of weight bearing (pull of gravity)

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25
Q

Femoral fractures are common in what population

A

Older females, secondary to osteoporosis

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26
Q

What are two examples of fractures of the proximal femur

A

Transcervical (middle of neck) and intertrochanteric

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27
Q

What may cause a proximal femur fracture

A

Indirect trauma (stumbling or stepping down hard, as off a curb or step)

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28
Q

Why are fractures of the proximal femur unstable, often resulting in impaction

A

The angle of inclination

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29
Q

What is impaction

A

Overriding of fragments resulting in foreshortening of the limb

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30
Q

What else may contribute to shortening of the limb with proximal femoral fractures

A

Muscle spasm

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31
Q

What is an intracapsular fracture of the femur

A

Within the hip joint capsule

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32
Q

What is a complication of an intracapsular fracture

A

Degeneration of the femoral head owing to vascular trauma

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33
Q

What may cause a fracture of the greater trochanterand femoral shaft

A 
Direct trauma (direct blows sustained by the bone resulting from falls or being hit) DURING ACTIVE YEARS
MVC, sports like skiing and climbing
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34
Q

Spiral fracture of the femoral shaft or grater trochanter

A

Results inforeshortening as the fragments override

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35
Q

Comminuted fracture of femur: greater trochanter and femoral shaft

A

Broken into several pieces

With fragments displaced in various directions as a result of muscle pull and depending on the level of the fracture

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36
Q

Fractures of the inferior or distal femur may be complicated by what

A

Separation of the condyles, resulting in misalignment of the articular surfaces of the knee joint or by hemorrhage from the large popliteal artery that runs directly on th posterior surface of the bone

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37
Q

Where does the popliteal artery run

A

Directly on the posterior surface of the femur

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38
Q

What is of concern if a fracture of the inferior or distal femur injures the popliteal artery

A

Comprises blood supply to the leg (always consider this occurrence with knee fractures or dislocations)

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39
Q

What should you always keep in mind with knee fractures or dislocations

A

The popliteal artery

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40
Q

Where is the tibial shaft narrowest

A

At the junction of its middle and inferior thirds

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41
Q

What is the most frequent site of fracture of the tibia

A

Where it is narrowest-the junction of its middle and inferior thirds

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42
Q

What area of the tibia has the poorest blood suppply

A

Where it is most common fractures and narrowest-the junction of its middle and inferior thirds

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43
Q

Bc its anterior surface is subcutaneous, the tibial shaft is the most common site of ____ fracture

A

Compound

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44
Q

What may cause a compound tibial fracture

A

Direct trauma (car bumper strikes leg)

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45
Q

Fracture of the tibia through the nutrient canal predisposes the patient to what

A

Nonunion of the bone fragments resulting from damage to nutrient artery

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46
Q

Who gets transverse march 9stress) fractures of the inferior third of thetibia

A

People who take long hikes before they are conditioned for them
The strain may fracture the anterior cortex of the tibia

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47
Q

How may someone fracture their tibial shaft

A

Indirect violence applied to the tibial shaft when the bone turns with the foot fixed (tackle in football)

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48
Q

What kind of tibial fracture may you get through severe torsion during skiing

A

Diagonal fracture of the tibial shaft at the junction of the middle and inferior thirds as well as fraction fo the fibula

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49
Q

What are diagonal fractures associated with

A

Limb shortening caused by overriding of the fractured ends

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50
Q

Boot top fracture

A

Frequently during skiing a fracture results from a high speed forward fall, which angles the leg over the rigid ski boot

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51
Q

When does the primary ossification center for the superior end of the tibia appear? When does it join the shaft?

A

Shortly after birth

During adolescence

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52
Q

Why are tibial fractures more serious in children if they involve the epiphyseal plates

A

Continued normal growth of the bone may be jeopardized

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53
Q

How does the tibial tuberosity form

A

Inferior bone growth from the superior epiphyseal center at 10 years of age
But a separate center for the tibial tuberosity may appear at age 12

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54
Q

Osgood-schlatter disease

A

Disruption of the epiphyseal plate at the tibial tuberosity may cause inflammation of te tuberosity and chronic recurring pain during adolescence , especially in young athletes

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55
Q

Most common spot for fibular fracture and what are they associated with

A

2-6 cm proximal to the distal end of the lateral malleolus

Associated with fracture-dislocation of the ankle joint , which are combined with tibial fractures

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56
Q

What happens when a person slips and the foot is forced into an excessively inverted position

A

Ankle ligaments tear forcibly tilting the talus against the lateral malleolus and may shear off

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57
Q

What group are lateral and medial malleolus fractures common in

A

Basketball players

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58
Q

Why are fibular fractures painful

A

Disrupted muscle attachments.

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59
Q

Why do fibular fractures compromise walking

A

Role in stability of the ankle

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60
Q

Radiographically sign of osgood schlatter disease

A

Prominence of tibial tuberosity elongated and fragmented with overlying tissue swelling

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61
Q

The __ is a common source of bone for grafting. Why

A

Fibula

Even after removing, running jumping and stuff is still normal

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62
Q

When a segment of fibula is taken out, why doesn’t it usually regenerate.

A

the periosteum and nutrientartery are generally removed with the piece of bone so that the graft will remain alive and grow when transplanted somewhere else

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63
Q

What does a fibular segment do at. A new site

A

Restores blood supply of the bone to which it is now attached. Healing proceeds as if a fracture had occurred at each of its ends

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64
Q

When performing free vascularized fibular transfers, why is it important to be aware of the location ofthe nutrient foramen in the fibula. Why

A

The segment of bone with the nutrient foramen is used for transplanting when the graft must include a blood supply to the medullary cavity as well as the compact bone of the surface

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65
Q

Where is the nutrient foramen of the fibula

A

Middle third of the fibula

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66
Q

Why may we use the subcutaneous anterior tibia

A

Grafting in kids

As a site of intraosseous infusion in dehydrated kids or kids with shock

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67
Q

Intraosseous infusion

A

Delivering hydration, blood, and medications directly into the medulary cavity of a bone when peripheral venous access is difficult or impossible

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68
Q

What causes do we primarily use intraosseous infusion

A

Traumatic shock

Children with circulatory collapse

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69
Q

What is the most common site for intraosseous infusion

A

Proximal tibia, due to thinness of the skin and existence of landmarks that aid int he correct insertion of the IO needle into the medullary cavity while avoiding the growth plate

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70
Q

What are some other sits for intraosseous infusion

A

Distal femur, tibia, fibula, proximal humerus, and manubrium

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71
Q

Describe intraosseous infusion of proximal tibia

A

Needle inserted into flat area of bone 2 cm distal and slightly medial fromt he tibial tuberosity

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72
Q

Why must interosseous infusion be replaced with peripheral venous or central line access within 24 hours

A

Risk of osteomyelitis

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73
Q

A hard fall onto the heel, may cause fracture in the ___ into several pieces. What is this type of fracture called

A

Calcaneous

Comminuted

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74
Q

Why is a calcanela fracture disabling

A

Disrupts the subtalar joint where the talus articulates with the calcaneous

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75
Q

Fractures of the Taler neck may occur with severe ___ of the ankl

A

Dorsiflexion

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76
Q

In some cases of fracture of Taler neck the body of the talus may dislocate ___-

A

Posteriorly

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77
Q

What often happens when a heavy object falls on the foot, or something runs over it or in female ballet dancers who use point shoes

A

Metatarsal fracture

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78
Q

Dancers fracture

A

Dancer loses balance , putting the full body weight on the metatarsal and fracturing the bone

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79
Q

Fatigue fractures of the metatarsals

A

From prolonged walking

Usually transverse, resulting from repeated stress on the metatarsals

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80
Q

What happens when the foot is suddenly and violently inverted

A

The tuberosity of the 5th metatarsal may be avulsed by the tendon of the fibular is brevis muscle

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81
Q

Who commonly gets avulsion fractures of the tuberosity of the 5th metatarsal

A

Basketball players and tennis players

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82
Q

Symptoms of avulsion fracture of the tuberosity of the 5th metatarsal

A

Pain and edema at the base of the 5th metatarsal and may be associated with a severe ankle sprain

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83
Q

Os trigonum

A

An accessory ossicle which occurs in 15-25% of adults , more commonly bilaterally, and is more prevelant among soccer players and ballet dancers

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84
Q

During ossification of the talus, the secondary ossification center, which becomes the lateral tubercle of the talus sometimes fails to unite with the body of the talus. What causes this failure

A 
Applied stress (forceful plantarflexion) during early teens 
Or sometimes a partly or even fully ossified center may fracture and progress to nonunion
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85
Q

What does this result in

A

Do trigonum

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86
Q

The ___ bones of the great toe in the tendon of the flexor hallucinations longus near the weight of the body, especially when

A

Sesamoid

During the latter part of the stance phase of walking

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87
Q

When and how do the sesamoid bones develop

A

Develop before birth and begin to ossify during late childhood

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88
Q

Fracture of the sesamoid bones may result from a ___ injury

A

Crushing

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89
Q

Lateral external hip rotation

A

L5, S1

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90
Q

Medial internal hip rotation

A

L4, L5

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91
Q

Hip adduction

A

L2-4

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92
Q

Hip abduction

A

L5, S1

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93
Q

Subtalar inversion

A

L4, L5

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94
Q

Subtalar Everion

A

L5, S1

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95
Q

Hip extension

A

L4, L5

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96
Q

Hip flexion

A

L3 L4

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97
Q

Knee flexion

A

L5 S1

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98
Q

Knee extension

A

L3, L4

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99
Q

Dorsiflexion

A

L4, L5

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100
Q

Plantarflexion

A

S1 s2

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101
Q

Toe extension

A

L5 S1

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102
Q

Toe flexion

A

S2 S3

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103
Q

Subcostal nerve

A

From T21 anterior ramus
Courses along inferior border of the 12th rib. Lateral cutaneous branch descends over iliac crest
Lateral cutaneous branch supplies skin of hip region inferior to anterior part of iliac crest and anterior to greater trochanter

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104
Q

Iliohypogastric nerve

A

From lumbar plexus (l1, occasionally t12)
Parallels iliac crest and divides into lateral and anterior cutaneous branches
Lateral cutaneous branch supplies superolateral quadrant of buttocks

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105
Q

Origin of ilioinguinal nerve

A

Lumbar plexus (l1, occasionally T12)

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106
Q

Course of ilioinguinal nerve

A

Passes through inguinal canal; divides into femoral and scrotal or labial branches

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107
Q

Distribution of ilioinguinal nerve

A

Femoral branch supplies skin over medial femoral triangle

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108
Q

Origin of genitofemoral nerve

A

Lumbar plexus (l1-l2)

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109
Q

Course of genitofemoral nerve

A

Descends anterior surface of psoas major, divides into genital and femoral branches

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110
Q

Distribution of genitofemoral nerve

A

Femoral branch supplies skin over lateral part of femoral triangle,genital branch supplies anterior scrotum or labia majora

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111
Q

Lateral cutaneous nerve of thigh origin

A

Lumbar plexus (l2-l30

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112
Q

Lateral cutaneous nerve of the thigh course

A

Passes deep to inguinal ligament, 2-3 cm medial to anterior superior iliac spine

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113
Q

Distribution distribution of the lateral cutaneous nerve of thigh

A

Supplies skin on anterior and lateral aspects of thigh

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114
Q

Origin of anterior cutaneous branches

A

Lumbar plexus (l2-l4)

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115
Q

Course of anterior cutaneous branches

A

Arise in femoral triangle, pierce fascia lata along path of sartorius muscle

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116
Q

Distribution of anterior cutaneous branches

A

Supply skin of anterior and medial thigh

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117
Q

Origin of the cutaneous branch of obturator nerve

A

Lumbar plexus via obturator nerve , anterior branch (l2-l4)

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118
Q

Course of cutaneous branch of obturator

A

Following its descent between adductors longus and brevity, anterior division of obturator nerve pierces fascia lata to reach skin of thigh

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119
Q

Distribution of the cutaneous. Branch of obturator nerve

A

Skin of middle part of medial thigh

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120
Q

Origin of the posterior cutaneous nerve of thigh

A

Sacral plexus s1-s3

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121
Q

Course of posterior cutaneous nerve of the thigh

A

Enters the gluteal region via infrapiriform portion of greater sciatic foramen deep to gluteus Maximus and then descends deep to fascia lata

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122
Q

Distribution of posterior cutaneous nerve of thigh

A

Terminal branches pierce fascia lata to supply skin of posterior thigh and popliteal fossa

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123
Q

Origin of saphenous nerve

A

Lumbar plexus via femoral nerve (l3-l4)

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124
Q

Course of saphenous nerve

A

Transverse adductor canal but does not pass through adductor hiatus. Crossing medial side of knee deep to sartorius tendon

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125
Q

Distribution fo the saphenous nerve

A

Skin on medial side of leg and foot

126
Q

Superficial fibular nerve origin

A

Common fibular nerve (L4-s1)

127
Q

Course of superficial fibular nerve

A

Courses through lateral compartment of leg; after supplying fibular muscles, perforated deep fascia of leg

128
Q

Superficial fibular nerve distribution

A

Skin of anterolateral leg and dorsomedial of foot, excluding web between great and 2nd toes

129
Q

Deep fibular nerve origin

A

Common fibular nerve (l5)

130
Q

Deep fibular nerve course

A

After supplying muscles on dorsomedial of foot, pierces deep fascia superior to heads of 1st and 2nd metatarsals

131
Q

Distribution of deep fibular nerve

A

Skin of web between great and 2nd toes

132
Q

Sural nerve origin

A

Tibial and common fibular nerves (s1-s2)

133
Q

Course of sural nerve

A

Medial sural cutaneous branch of tibial nerve and lateral sural cutaneous branch of fibular nerve to merge at varying levels on posterior leg

134
Q

Distribution of sural nerve

A

Skin of posterolateral leg and lateral margin of foot

135
Q

Origin of medial plantar nerve

A

Tibial nerve (l4-L5)

136
Q

Course of medial plantar nerve

A

Passes between first and second layers of plantar muscles and then between medial and middle muscles of first layer

137
Q

Distribution of medial plantar nerve

A

Skin of medial side of sole and plantar aspect, sides and main beds of medial 3.5 toes

138
Q

Lateral plantar nerve origin

A

Tibial nerve s1-s2

139
Q

Lateral plantar nerve course

A

Passes between first and second layers of plantar muscles and then between middle ad lateral muscles of first layer

140
Q

Distribution of lateral plantar nerve

A

Skin of lateral sole, and plantar aspect, sides, and nail beds of lateral1.5 toes

141
Q

Calcaneal nerve origin

A

Tibial and sural nerves s1-s2

142
Q

Calcaneal nerves course

A

Lateral and medial branches of tibial and sural nerves, respectively, over calcaneal tuberosity

143
Q

Distribution of calcaneal nerves

A

Skin of heels

144
Q

Superior clunial nerve origin

A

L1-L3 posterior rami

145
Q

Course of superior clunial nerves

A

Penetrate thoracodorsal fascia; course laterally and inferiorly in subcutaneous tissues

146
Q

Distribution of superior clunial nerves

A

Skin overlyingsuperior and central parts of buttocks

147
Q

Medial clunial nerve origin

A

S1-s3 posterior rami

148
Q

Medial clunial nerve course

A

Emerge from dorsal sacral foramina; directly enter overlying subcutaneoustissue

149
Q

Distribution of medial clunial nerves

A

Skin of medial buttocks and intergluteal cleft

150
Q

Inferior clunial nerve origin

A

Posterior cutaneous nerve of thigh (s2-s3)

151
Q

Inferior clunial nerves course

A

Arise deep to gluteus Maximus; emerge from beneath inferior border of muscle

152
Q

Distribution of inferior clunial nerves

A

Skin of inferior buttocks (overlying gluteal fold)

153
Q

The fascial compartments of the lower limbs are generally ___ spaces, ending proximally and distally at the joints

A

Closed

154
Q

Trauma to muscles and/or vessels in the compartments from burns , sustained intense use of muscles, or blunt trauma may produce what

A

Hemorrhage, edema, inflammation of muscles

155
Q

Bc the septa and deep fascia of the leg forming the boundaries of the leg compartments are strong,the increased volume may increase ____ ___

A

Intracompartmental pressure

Compartment syndrome!!

156
Q

Issues with increased intracompartmental pressure

A

Compress structures, like the small vessels and nerves (vasa nervorum)
Ischemia
Adversely effects circulation and threatens the function of tissue within or distal to the compartment syndromes

157
Q

What is an obvious sign of arterial compression in compartment syndrome

A

Loss of distal leg pulses

Lowering temperature of tissue distal to compression

158
Q

Fasciotomy

A

Incision of overlying fascia of a septum

Performed to relieve th pressure in the compartment

159
Q

Frequently, the great saphenous vein and its tributaries become ___

A

Varicose

160
Q

What are varicose veins

A

Dilated vines so that the cusps of the valves do not close

161
Q

Where are varicose veins common

A

Posteromedial parts of lower limb and may cause discomfort

162
Q

What is the function of normal vein valves

A

Valves allow blood flow to the heart while keeping blood from flowing away from the heart

163
Q

Varicose vein valve

A

Incompetent due to dilation or rotateion

BLOOD FLOWS INFERIORLY IN THE VAINS PRODUCING VARIOSE

164
Q

Dvt characterization

A

Swelling, warmth, and erythema

165
Q

__ __ is an important cause of thrombus formation

A

Venous stasis (stagnation)

166
Q

What can cause venous stasis

A 
Incompetent loose fascia that fails to resist muscle expansion, diminishing the effectiveness of the musculovenous pump
External pressure on the veins from bedding during a prolonged hospital stay of from a tight cast or bandage
Muscular inactivity (flight)
167
Q

Thrombophlebitis

A

Dvt with inflammation around the involved veins

168
Q

A large thrombus that breaks free from a lower limb b=vein may travel to a ___, forming what

A 
Lung
Pulmonary thromboembolism (obstruction of a pulmonary artery)
169
Q

A large embolus may obstruct a main pulmonary artery and cause ___

A

Death

170
Q

Why is the great saphenous vein sometimes used for coronary bypasses

A

-readily accessible
Sufficient distance occurs between the tributaries and the perforating veins so that usable lengths can be harvested
Its wall contains a higher percentage of muscular and elastic fibers than superficial veins

171
Q

Saphenous veins grafts are used for what

A

To bypass obstructions in blood vessels

172
Q

When part of the great saphenous vein is removed for bypass why is the vein inverted

A

So valves do not obstruct blood flow in the venous graft

173
Q

Does removal of great saphenous vein cause problems

A

Rarely bc so many other leg veins if deep veins are in tact

174
Q

Removal of the great saphenous vein may facilitate the superficial to dee drainage pattern to take advantage of the ____ ___

A

Musculovenous pump

175
Q

Who may the great saphenous vein not be visible in

A

Infants
Obese people
Patients in shock who have collapsed veins

176
Q

How can the great saphenous vein always be located

A

Making a skin incision anterior to the medial malleolus

177
Q

Saphenous cut down procedures

A

Skin incision anterior to the medial malleolus

Used to insert a cannula for prolonged administration of blood, plasma expanders , electrolytes or drugs

178
Q

The saphenous nerve accompanies the great saphenous vein __ to the medial malleolus

A

Anterior

179
Q

What happens is saphenous nerve cut during saphenous cutdown or ligated during closure of surgical wound

A

Pain or numbness along medial border of food

180
Q

Can you palpate the superficial inguinal lymph nodes

A

No locked in subcutaneous tissue

181
Q

Enlarged inguinal lymph nodes in female

A

Metasticisis of uterine cancer (drains uterine fundus) may flow along lymphatics accompanying the round ligament of the uterus through the inguinal canal to reach the superficial inguinal lymph nodes

182
Q

How do we do a nerve block of lower limbs

A

Perineural injection of anesthetics close to the nerves whose conductivity is to be blocked

183
Q

How can you block the femoral nerve

A

L2-l4

2cm inferior to the inguinal ligament , 1 finger breath lateral to the femoral artery

184
Q

How would you know if the saphenous nerve is affected

A

Paresthesia radiates to the knee and over the medial side of the leg

185
Q

Hip pointer

A

Contusion of the iliac crest that usually occurs at its anterior part (here the sartorius attaches to the ASIS)

186
Q

How do people get contusion of the iliac crest

A

Collision sports, such as various forms of football, ice hockey, and volleyball

187
Q

What does avulsion of the iliac crest cause

A

Bleeding from ruptured capillaries and infiltration fo blood into he muscles, tendons, and other soft tissue

188
Q

What else may hip pointer refer to, although they should be called avulsion fractures

A

Avulsion of bony muscle attachments for example, of the sartorius or rectus femoris to the anterior superior and inferior=riot iliac spines, respectively, of the hamstrings from the ischium

189
Q

Charley horse

A

Crampingof an individual thigh muscle because of ischemia or to contusion and rapture of blood vessels sufficient enough o form a hematoma

190
Q

What causes charley horse

A

Tearing of fibers of the rectus femoris; sometimes, the quadriceps tendon too

191
Q

What is the most common site of thigh hematoma

A

Quadriceps

192
Q

A charley horse is associated with __ pain and/or muscle ____ and commonly follows direct trauma (hockey stick slash)

A

Localized

Stiffness

193
Q

What does the psoas major arise from

A

IV discs, sides of T12-L5 vertebrate and their TP

194
Q

The __ ___ ligament of the diaphragm arches obliquely over the proximal part of the psoas major

A

Medial arcuate

195
Q

The ____ fascia on the internal abdominal wall os continuous with the psoas fascia, where it forms a fascial covering for the psoas major that accompanies the muscle into the anterior region of the thigh

A

Transversalis

196
Q

There is a resurgence of __ in Africa, Asia, and elsewhere

A

TB

197
Q

Causes of psoas abscess

A

TB -retroperitoneal pyogenic infection in the abdomen or greater pelvis, characteristically associated with TB in vertebral column

Secondary to regional enteritis of the ileum (crohns)

198
Q

What happens when the abscess passes between the psoas and its fascia to the inguinal and proximal thigh regions,

A

Severe pain may be referred to the hip, thigh or knee joint

199
Q

When should a psoas abscess always be considered

A

When ede,a occurs in the proximal part of the thigh

200
Q

Can you observe or palpate a psoas abscess

A

Inguinal region just inferior or superior to the inguinal ligament

201
Q

What may a psoas abscess be mistaken for

A

Indirect inguinal hernia , femoral hernia, enlargement of inguinal nodes, or saphenous varicose

202
Q

The ___ border of the psoas is commonly visible in radiographs of the abdomen;an obscured psoas shadow may be an indication of abdominal pathology

A

Lateral

203
Q

Paralyzed quadriceps muscles

A

Can’t extend the leg against resistance

204
Q

How does someone with paralyzed quadriceps muscle walk

A

With a forward lean, pressing on the distal end of the thigh with their hand as the heel contacts the ground to prevent inadvertent flexion of the knee joint

205
Q

What does weakness of the vastus medialis or vastus lateralis, resulting from arthritis or trauma to the knee joint cause

A

Abnormal patellar movement and loss of joint stability

206
Q

Chondromalacia patellar or “runners knee”

A

Marathon runners, basketball

Softening of the articular cartilage of the patella

207
Q

In chondromalacia patellae, the soreness and aching around or deep to the patella often result from ___ ___

A

Quadriceps imbalance

208
Q

Chondromalacia patellae may also result from a blow to patella or extreme ____ of the knee (squatting or power lifting

A

Flexion

209
Q

Direct blow to the patella

A

Fracture into two or more fragments!

210
Q

Transverse patellar fractures, how get them

A

From a blow to knee or sudden contraction of quadriceps , like when one slips and tries to prevent a backwards fall

211
Q

In a transverse patellar fracture, the proximal fragment is pulled superiorly with the ____ ____ and the distal fragment remains with the patellar ligament

A

Quadriceps tendon

212
Q

The patella is cartilaginous at birth . It ossified when

A

Years 3-6, frequently from more than one ossification center

213
Q

Bipartite or tripartite patella

A

Although ossification centers usually coalesce and form a single bone , they may remain separate on one or both sides

214
Q

What may bipartite or tripartite be mistaken as

A

Patellar fracture

215
Q

Are ossification abnormalities of the patella are unilateral or bilateral

A

Bilateral

216
Q

How can you tell bipartite and tripartite from fracture of patella

A

Radiographically from looking at both patella

Bilateral are likely to be ossification abnormalities

217
Q

Patellar tendon/myotactic DTR

A

Quadriceps should contract

L2-L4

218
Q

Tapping the patellar ligament activates muscle spindles in the ___. Afferent imposes fromt he spindles trail in the ____ nerve to the l2-L4 segments of the spinal cord. From here , efferent impulsesare transmitted via motor fibers in the ___ nerve to the ____ muscles to cause __ of the leg

A

Quadriceps
Femoral femoral
Quadriceps
Extension

219
Q

Why have diminution or abscence of the patellar tendon reflex

A

Lesion that interrupts the innervation of the quadriceps (peripheral nerve disease

220
Q

Why’d an the gracilis be removed without noticeable effects

A

Weak member of adductors

221
Q

Why would surgeons transplant gracilis

A

With its nerve and blood vessels to replace a damaged muscle in the hand
Once implanted it produced good digital flexion and extension
OR can be repositioned to create a replacement for a non function external anal sphincter

222
Q

Pulled groin

A

Strain , stretching and maybe tearing of the proximal attachments of the anteromedial thigh muscles

223
Q

What muscles are involved in pulled groin

A

Flexor and adductor thigh muscles

224
Q

What are the proximal attachments of the flexor and adductor thigh muscles

A

Inguinal region(groin) and junction of the thigh and trunk

225
Q

Groin pulls occur in what sports

A

That require quick starts or extreme stretching (gymnastics, baseball)

226
Q

How get a muscle strain of the adductor longus

A

Sports that require fast acceleration , deceleration, or changes in direction
Hockey, cricket, breaststroke swimming, football, and rugby

227
Q

Rides strain

A

Horseback riders

Muscle strains of the adductor longus

228
Q

Why do riders get ossification in the tendons of the adductor longus

A

Actively adduct their thighs to keep from falling from their animals.

229
Q

Why use the initial part of the femoral artery, proximal to the branching of the profunda femoris artery in procedures(the common femoral artery)

A

Superficial in position

230
Q

With a person lying in the supine position , where may the femoral pulse be palpated

A

Midway between the asis and the pubic symphysis

231
Q

How would you palpate it

A

Thumb on pubic tubercle, pinky on asis and can feel with midpalm on just inferior to the inguinal ligament by pressing firmly

232
Q

Normally the pulse of the femoral artery is strong. Why would it be weak

A

Common or external iliac arteries are partially occluded

233
Q

Compression of the femoral artery may also be accomplished at this site by pressing directly posteriorly against the ___ __ __, __ __ and __ __-

A

Superior pubic ramus
Psoas major
Femoral head

234
Q

Why compress the femoral artery here

A

Reduce blood flow through the femoral artery and its branches such as the profunda femoris artery

235
Q

The femoral artery may be cannulated just inferior to the midpoint of the inguinal ligament

A

Ok

236
Q

Left cardinal angiography

A

Long slender catheter is inserted into the artery and passes up the external iliac artery, common iliac artery, and aorta to the left ventricle of the heart.

237
Q

Coronary arteriography

A

Same approach

238
Q

Blow may also be taken from the femoral artery for blood gas analysis

A

To determine oxygen and carbon dioxide concentration and pressures with the pH of the blood by laboratory tests

239
Q

The ___ position of the femoral artery in the femoral triangle makes it vulnerable to traumatic injury, especially laceration

A

Superficial

240
Q

What is commonly lacerated in anterior thigh wounds

A

Femoral artery and vein

241
Q

What is a concern if lacerate the femoral artery and vein

A

Arteriovenous shunt

242
Q

Ligate femoral artery. The ___ anastomoses helps

A

Cruciate

243
Q

Describe the cruciate anastomses

A

Four way common meeting of the medial and lateral circumflex femoral arteries with the inferior gluteal artery superiorly and the first perforating artery inferiorly, posterior to the femur, occurring less often tha its frequent mention implies

244
Q

Superficial femoral??

A

Its actually deep . Do not use this terminology

They are in the subcutaneous tissue

245
Q

Most pulmonary emboli originate where

A

Deep veins, not superficial

246
Q

Issue with calling femoral artery or vein superficial

A

Could overlook this spot for emboli
They are deep
Anticoagulants help

247
Q

Saphenous varix

A

Localized dilation of the terminal part of the great saphenous vein

248
Q

What may saphenous varix cause

A

Edema int he femoral triangle

249
Q

What may a saphenous varix be confused with

A

Other groin swelling.

250
Q

When should saphenous varix be considered

A

Varicose veins are present in other parts of th lower limbs

251
Q

We cant palpate the femoral vein. But how can it be found

A

Inferior to the inguinal ligament by feeling the pulsation of the femoral artery which is immediately lateral to the vein

252
Q

Don’t mistake the femoral vein for saphenous vein in thin people! How tell which is which

A

Femoral vein has no tributaries right under inguinal ligament , except for the great saphenous vein that joins it 3 cm inferior to the inguinal ligament

253
Q

In varicose vein operation why identify the great saphenous vein

A

So tie it off and not tie off the femoral vein by mistake

254
Q

Cannulation of femoral vein

A

To get blood samples and take pressure from right side of hear or pulmonary artery and to do right cardiac angiography, a long slender catheter is inserted into the femoral vein as it passes through the femoral triangle. It is passed superiorly through the external and common iliac veins into the inferior vena cava and right atrium of the heart

255
Q

Femoral venous puncture

A

For the administration of fluids

256
Q

What is the femoral ring

A

Weak area int he anterior abdominal wall that normally is the size sufficient to admit tip of little finger

257
Q

Femoral hernia

A

A protrusion of abdominal viscera (intestine). Through the femoral ring into the femoral canal

258
Q

How does a femoral hernia appear

A

A mass , often tender, in the femoral triangle, inferolateral tothe pubic tubercle

259
Q

What is a femoral hernia bounded by laterally and medially

A

Laterally-femoral vein

Medially-lacunar ligament

260
Q

The hernial sac compresses the contents of the femoral canal and distends the wall of the canal . What is in the femoral canal

A

Loose CT, fat, lymphatics

261
Q

Initially a femoral hernia is small bc it is contained in the canal. How does it become large

A

Passing inferiorly through the saphenous opening into the subcutaneous tissue of the thigh

262
Q

Are femoral hernias more common in males or females

A

Females

263
Q

Why are femoral hernias more common in females

A

Wider pelvis and smaller inguinal canal and rings, multiple pregnancies due to enlargement of the femoral ring over time fromt he femoral canal

264
Q

What kind of pain is associated with femoral hernia

A

Hip or abdominal

265
Q

Strangulation of femoral hernia

A

Bc the sharp rigid boundaries of the femoral ring, particularly the concave margin of the lacunae ligament.

266
Q

Concern of strangulation of a femoral hernia

A

Interferes with the blood supply to the herniated intestine

Necrosis

267
Q

What happens to an enlarged pubic branch of the inferior epigastric artery

A

Either takes the place of the obturator artery or joins it as an accessory obturator artery in 20% of people

268
Q

Where does the accessory or replaced obturator artery run

A

Close to or across the femoral ring to reach the obturator foramen and could be closely related to the neck of a femoral hernia

269
Q

Does the accessory or replaced obturator artery ever get involved in strangulated femoral hernia

A

Yea

270
Q

Surgeons placing staples during endoscopic repair of both inguinal and femoral hernias must also be vigilant concerning the possible preserve of this common arterial variant

A

Sure

271
Q

Trochanteric bursitis

A

Inflammation of the trochanteric bursa

272
Q

What may cause trochanteric bursitis

A

Repetitive actions such as climbing stairs while carrying heavy objects or running on a steeply elevated treadmill

273
Q

What do these movements involve (running on a steep treadmill or climbing stairs)

A

Gluteus Maximus= and move the superior tendinous fibers repeatedly back and forth over the bursa of the greater trochanter.

274
Q

Pain from trochanteric bursa

A

Deep diffuse pain in the lateral thigh region

275
Q

Characterization of friction bursitis

A

Point tenderness over the great trochanter; however the pain radiates along iliotibial tract that extends form the iliac tubercle to the tibia

276
Q

Thickening of the fascia lata receives tendinous reinforcements from what

A

Tensor fascia lata and gluteus Maximus muscles

277
Q

Pain from an inflamed trochanteric bursa

A

Localized just posterior to the greater trochanter , is generally elicited by manually resisting abduction and lateral rotation of the thigh whole the person os lying on the unaffected side

278
Q

What causes ischial bursitis

A

Recurrent microtrauma resulting from repeated stress may overwhelm the ability of the ischial bursa to dissipate applied stress

279
Q

Ischial bursitis is a friction bursitis resulting from what

A

Excessive friction between the ischial bursa and the ischial tuberosities

280
Q

With ischial tuberosity, localized pain occurs over the bursa and the pain increases with movement of the ___ ___

A

Gluteus Maximus

281
Q

___ may occur in the bursa with chronic bursitis

A

Calcification

282
Q

Bc the ischial tuberosities bear the bodies weight during sitting, these pressure points may lead to __ __ in debilitated people , particularly paraplegic persons with poor nursing care

A

Pressure sores

283
Q

Hamstring strain; who gets them

A

Individuals who run and/or kick hard

284
Q

The violent muscular exertion required to excel in these sports may ___ part of the proximaltendinous attachments of the hamstring to the ischial tuberosity

A

Avulse

285
Q

Hamstring strains are _ as common as quadricep strains

A

Twice

286
Q

Usually thigh strains are accompanied by contusion and tearing of muscle fibers, resulting in rupture of the bloodvessels supplying the msucles

A

The resultant hematoma is contained by the dense stocking like fascia lata

287
Q

Tearing of the hamstring fibers is often so painful that when the athlete moves or stretches the leg that the person falls and writhes in pain

A

These injuries often result from inadequate warming up before practice or competition

288
Q

Avulsion if the ischial tuberosity at the proximal attachment of the biceps femoris and semitendinosus may result from forcible flexion of the hip with the knee extended

A

Ok

289
Q

Injury to the superior gluteal nerve results in what

A

Disabling gluteus mediums limp

290
Q

Why do people with injury to the superior gluteal nerve cause a gluteus mediums limp

A

Compensate for the weaker abduction of the thigh by the gluteus mediums and minimus and or gluteal gait.

291
Q

Describe gluteal gait

A

Compensation places the center of gravity over the supporting lower limb
Medial rotation fothe thigh is also severely impaired

292
Q

What test tests gluteus mediums

A

Trendelenburg test

293
Q

Which superior gluteal nerve is damaged if left hip drops when on right foot

A

Right

294
Q

What could cause a positive trendelenberg test

A

Injury to superior gluteal nerve
Fracture of the greater trochanter
Dislocation of the hip joint

295
Q

When the pelvis descends not he unsupported side, the lower limb becomes , in effect __ ___ and does not clear the grounf

A

Too long

296
Q

How does one compensate

A

Waddling or gluteal gait
Steppage
Swing out

297
Q

How do you compensate for foot drop

A

Same

298
Q

How block sciatic nerve pain

A

Injections. Few cm inferior to the midpoint of the line joining the posterior superior iliac spine and the superior border of the greater trochanter

299
Q

How does it anesthic of sciatic nerve present

A

Paresthesia radiates to the foot because of anesthesia of the plantar nerves, which are terminal branches of the tibial nerve derived from the sciatic nerve

300
Q

Compression of the sciatic nerve by the piriformis results in what “piriformis syndrome”

A

Pain in buttocks

301
Q

Whoa re likely to develop piriformis syndrome

A

Ice skaters, cyclists, rock climbers and women

302
Q

In 50% of piriformis syndrome there has been trauma to

A

Buttocks associated with hypertrophy and spasm of the piriformis

303
Q

Complete section fothe sciatic nerve

A

May involve inferior gluteal and or the posterior femoral cutaneous nerves. Recovery si slow and incomplete

304
Q

What is the side of safety and side of danger

A

With respect to the sciatic nerve, the buttocks have a side of safety (lateral)and a side of danger (medial).

305
Q

Wounds or surgery on the medial side of the buttocks may injure the sciatic nerve and its branches to the hamstrings on the posterior aspect of the thigh(semitendinosus, semimembranosus, biceps femoris)

A

Paralysis of these msucles results in impairment of the thigh extension and leg flexion

306
Q

The gluteal region is a common site for intramuscular injection of drugs. Gluteal IM penetrate the skin, fascia, and muscles

A

Te gluteal region is a common injection site because the muscles are thick and large; consequently they provide a substantial volume for absorption of injection substance by IM veins. It is important to be aware of the extend of the gluteal region and the safe region for giving injections

307
Q

Some people restrict the area of the buttocks to the most prominent part. This misunderstanding may be dangerous. Why

A

The sciatic nerve lies deep to this area .

308
Q

Injections into the buttocks are safe only in what quadrant

A

Superolateral quadrant of the buttocks or superior to a line extending from the PSIS to the superior border of the greater trochanter(approximating the superior border of the gluteus Maximus)

309
Q

IM injections can also be given safely into the anterolateral part of the thigh where the needle enters the gluteus medius or tensor fascia lata as it extends distally from the iliac crest and ASIS

A

The index finger is placed on the ASIS and the fingers are spread posteriorly along the iliac crest until the tubercle of the crest is felt by the middle finger

310
Q

An IM injection can be made safely in the triangular area between the fingers because it is superior to the sciatic nerve

A

Complications of improper techniques include nerve injury, hematoma, and abscess formation

Moores Blue Boxes (15 decks)

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