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OSPE > Lower Limbs > Flashcards

Lower Limbs Flashcards

1
Q

Identify femur, patella, tibia, fibula, tarsals, metatarsals, phalanges

A

Do it

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2
Q

What’re the main bones of the leg

A

femur, patella, tibia, fibula, tarsals, metatarsals, phalanges

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3
Q

What’re the important bony features of the bones of the leg? Know where they are

A

Greater trochanter of femur, proximal head of the fibula, lat. and med. malleolus, sesamoid bones

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4
Q

What is a sesamoid bone

A

Bone embedded within a tendon or muscle

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5
Q

What’re the arches in the foot

A

Medial, lateral and transverse arch

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6
Q

Test gluteus medius/minimum

A

lie on side with lower limb fully extended. Abduct limb against resistance at distal end of thigh. Palpate contraction of gluteus medius just inferior to iliac crest. (nerve = superior gluteal L5, S1

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7
Q

Trendelenberg test

A

tests integrity of abductors at hip joint. Stand on both legs, both right and left side of pelvis should remain at the same level. Examiner stand behind and feel the pelvis. Ask subject to raise one leg. Pelvis should remain horizontal. If pelvis on raised leg side drops down, test is positive – loss/weakness of motor function of abductor muscles (gluteus medius and minimus) in supporting leg

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8
Q

Test iliopsoas muscle

A

hip flexor in the anterior compartment of the thigh/pelvis.
Patient lies supine with knee flexed at 90 degrees
 Stand with hand placed on individual’s flexed knee
 Patient further flexes against resistance

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9
Q

What is the anterior quadriceps group of muscles

A

rectus femoris, vastus medialis, intermedius, lateralis

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10
Q

Test the anterior quadriceps group

A

Subject sits on edge of couch, knees bent to 90 degrees. Examiner resist extension of leg. Palpate contracting quadriceps on anterior thigh. (Nerve = femoral, L2,3,4)

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11
Q

What’re the hamstrings group of muscles

A

Biceps femoris, semitendinosus, semimembranosus

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12
Q

What is the adductor group of muscles of the thigh

A

Adductor longis, brevis and magnus

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13
Q

Test the adductor group of muscles of the thigh

A

Lie on side, support upper leg, request them to adduct lower leg against resistance. (Nerve = obturator nerve L2,3,4)

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14
Q

Test the tibialis anterior

A

subject turn foot inwards and upward (inversion) while examiner grasps the forefoot to oppose the movement. Tendon becomes prominent and is palpated just below and anterior to the medial malleolus (Nerve = deep fibular (peroneal) L4,5)

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15
Q

Test the fibulas longus and brevis

A

Subject asked to turn foot outwards and plantar flex (eversion) while examiner grasps forefoot to oppose movement. Tendons become prominent and palpated just below lateral malleolus (Nerve = superficial fibular L5, S1, S2)

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16
Q

What are the calf muscles

A

gastrocnemius, soleus, calcaneal tendon

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17
Q

Test the calf muscles

A

Subject stands on toes. Muscle belies, calcaneal tendon is seen and palpated in the calf area and on the posterior side of the ankle. (Nerve = tibial S1, S2)

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18
Q

Nerve supply to gluteal muscles

A

gluteal nerve

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19
Q

Nerve supply to Tensor fascia lata

A

superior gluteal L5, S1

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20
Q

Nerve supply to Iliopsoas muscles

A

femoral nerve and direct branches of lumbar plexus

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21
Q

Nerve supply to quadriceps group

A

Nerve = femoral, L2,3,4

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22
Q

Nerve supply to hamstrings

A

nerve = tibial division of sciatic L5, S1, S2 except for biceps short head = common fibular division L5, S1, S2

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23
Q

Nerve supply to adductor group

A

= obturator nerve L2,3,4

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24
Q

Nerve supply to tibialis anterior

A

deep fibular (peroneal) L4,5

25
Q

Nerve supply to fibularis (peroneus) longus and brevis

A

superficial fibular L5, S1, S2

26
Q

Nerve supply to o Calf muscles – gastrocnemius, soleus, calcaneal tendon

A

(Nerve = tibial S1, S2)

27
Q

Where do you palpate the femoral pulse

A

at mid-inguinal point between ASIS and pubic symphysis

28
Q

Where do you palpate the popliteal pulse

A

subject lies prone with knee flexed. Palpated in inferior part of popliteal fossa in relation to the tibia

29
Q

Dorsalis pedis pulse

A

palpate just lateral to extensor hallucis longus tendon (this can be found by asking subject to dorsiflex toes while resisting movement

30
Q

Tibialis posterior pulse

A

palpate just behind medial malleolus

31
Q

Surface mark long and short saphenous vein

A

Do it

32
Q

Describe long saphenous vein

A

runs upwards 2cm in front of the medial malleolus, along medial side of leg, hands width along the medial side of patella, along medial side of thigh to saphenous opening in inguinal region.

33
Q

Describe short saphenous vein

A

passes posteriorly to the lateral malleolus at the ankle, runs superiorly on the posterior leg to drain into the popliteal vein after piercing the fascia over the popliteal fossa.

34
Q

Map dermatomes L1 to S2

A

Do it

35
Q

Test patellar tendon. What nerve?

A

sit with legs dangling. Strike patella tendon, should see brisk extension of the knee joint & should be able to palpate simultaneous contraction of the quadriceps on anterior thigh. L4

36
Q

Test ankle jerk. What nerve?

A

sit with legs dangling. Strike the calcaneal tendon while holding the foot slightly dorsiflexed. Should see plantar flexion of ankle joint. S1

37
Q

Surface mark sciatic nerve

A

first palpate PSIS, ischial tuberosity, greater trochanter. Nerve leaves the greater sciatic notch, enters gluteal region at midpoint between PSIS and ischial tuberosity. Forms downward curve to pass into thigh around midpoint between greater trochanter and ischial tuberosity before reaching popliteal fossa.

38
Q

Test motor function of the sciatic nerve

A

Subject lies prone, knee flexed to 30 degrees. Resist further flexion. Hamstring tendons seen around popliteal region, muscle contraction palpable on posterior side of mid-thigh

39
Q

Where does the sciatic nerve exit the vertebral column and what does it supply

A

supplies hamstring muscles & all muscles below level of knee (through its divisions) (L3,4,5,S1,S2

40
Q

Test motor function of the gluteal nerve

A

. Lie on side with lower limb fully extended. Abduct limb against resistance at distal end of thigh. Palpate contraction of gluteus medius just inferior to iliac crest.

41
Q

What does the gluteal nerve supply

A

supplies gluteus medius, minimus, maximus

42
Q

What does the femoral nerve supply

A

supplies psoas, iliacus, pectineus, sartorius, rectus femoris, vastus

43
Q

What does the obturator nerve supply

A

supplies obturator externus, adductor brevis, adductor longus, adductor magnus, gracilis

44
Q

What does the superficial peroneal nerve supply

A

supplies peroneus longus, brevis

45
Q

What does the deep peroneal nerve supply

A

supplies extensor digitorum longus, brevis, extensor hallucis longus, tibialis anterior, peroneus tertius

46
Q

Test motor function of the femoral nerve

A

Flex hip against resistance and extend knee

47
Q

Test motor function of the obturator nerve

A

Lie on side, support upper leg, request them to adduct lower leg against resistance.

48
Q

Test motor function of the superficial peroneal nerve

A

Subject asked to turn foot outwards and plantar flex (eversion) while examiner grasps forefoot to oppose movement.

49
Q

Test motor function of the deep peroneal nerve

A

Subject turn foot inwards and upward (inversion) while examiner grasps the forefoot to oppose the movement

50
Q

Demonstrate how to define the Gluteal “safe area”

A
  • Superior lateral quadrant of the buttock
  • Avoid hitting the sciatic nerve (and superior gluteal nerve and vessels) during i.m. injection
  • Between the tubercle of the iliac crest and the anterior superior iliac spine
  • Place index finger on ASIS and spread fingers posteriorly until the middle finger feels the tubercle of the iliac crest
  • The triangle between those 2 fingers is the safe area for i.m. injections
51
Q

Define the femoral triangle borders

A

outlined by inguinal ligament (superiorly), adductor longus (medially), sartorius (laterally

52
Q

What does the femoral triangle contain

A

Contains femoral nerve, artery, vein (lateral to medial)

53
Q

Define the popliteal fossa borders

A

outlined by biceps femoris (superolaterally), semimembranosus (superomedially), lateral and medial gastrocnemius (inferiorly), skin and fascia (posteriorly), femur (anteriorly).

54
Q

What does the popliteal fossa contain

A

Contains popliteal artery, vein, tibial and common peroneal nerve, short saphenous vein, popliteal lymph nodes

55
Q

Test the hamstring group of muscles

A

Subject lies prone, knee flexed to 30 degrees. Resist further flexion. Hamstring tendons seen around popliteal region, muscle contraction palpable on posterior side of mid-thigh (nerve = tibial division of sciatic L5, S1, S2 except for biceps short head = common fibular division L5, S1, S2)

56
Q

What are the gluteal muscles (5)

A

Gluteus medius, minimus and maximus, tensor fascia lata and iliopsoas

57
Q

What are the three groups of thigh muscles

A

Anterior quadriceps group, hamstrings, adductor group

58
Q

Nerve supply to the gluteal medius

A

Superior gluteal L5, S1

OSPE (7 decks)

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