Texas Tech questions Flashcards
Which nerve provides cutaneous innervation to the medial leg and foot, but no motor innervation?
Saphenous nerve
Which nerve sensorily innervates the distal third of the leg and dorsal surface of the foot
superficial fibular nerve
Which nerve innervates the muscles of the anterior compartment of the leg and skin between 1st and second toe?
deep fibular nerve (Foot drop is primary symptom)
Which nerve is responsible for foot drop, and which muscles are involved in this?
Deep fibular/peroneal nerve
Innervates the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and fibularis tertius muscles, The extensor digitorum brevis and the first two dorsal interossei muscles in the dorsum of the foot
Where does the great saphenous vein travel in respect to the knee and ankle?
Travels posterily to medial condyle of femur and then anterior to medial malleolus
Where does the lesser saphenous vein travel in the ankle?
Posterior to the lateral malleolus
Where do the lymph from the skin of the lower limbs drain?
They drain into the superficial inguinal lymph nodes
- Anal canal below pectinate line, external genitalia, lower abdominal wall drain to inguinal lymph nodes
Which nerve provides cutaneous innervation to the lower anterior leg and dorsum of the foot?
Superficial fibular
What do the anterior femoral cutaneous branches of the femoral nerve provide sensory innervation to
medial and anterior thigh
Which nerve provides sensory innervation to the posterior surface of the leg and lateral side of foot
lateral sural cutaneous nerve from the common fibular nerve
What are the boundaries of the femoral triangle
Superior: Inguinal ligament
Lateral: Medial edge of sartorius
Medial: medial edge of adductor longus
Which structures pass deep to the inguinal ligament
Femoral nerve, artery, and vein, psoas major
What is the primary nerve responsible for adduction
Obturator
When walking, the action of the iliopsoas muscle results in what motion at the hip joint?
Flexion
The pulse of the femoral artery is best felt at which superficial reference point?
Femoral triangle
If the femoral artery is occluded at the beginning of the adductor canal, which artery could help provide viability to the leg through collateral circulation?
Descending branch of the lateral circumflex femoral
At which site could one expect to enter the femoral vein with a simple percutaneous (through the skin) introduction of an instrument?
Medial to the femoral arterial pulse (NAVL with nerve being most laterally)
What is the roof of the adductor canal
Sartorius
What are the contents of the adductor canal
Femoral artery, femoral vein, saphenous nerve, nerve to vastus medialis
What makes up the posterior boundary of the adductor canal
Adductor longus and magnus
What makes up the lateral boundary of the adductor canal
Vastus medialis
What are the boundaries of the adductor canal
Roof/lateral: Sartorius
Posterior/deep boundary: Adductor longus
Medial boundary: Vastus medialis
Contents: Femoral artery/vein, saphenous nerve, nerve to vastus medialis
Which artery supplies blood to the femoral neck
Medial circumflex femoral
Which artery supplies the lateral thigh and hip
Descending branch of lateral circumflex femoral
Which artery supplies posterior thigh
Perforating branches of deep femoral artery
Where does the femoral artery branch into the deep femoral artery
In the femoral triangle
What are the most important leg extensors
the quadriceps muscles
Which nerve impairment results in impaired adduction
Obturator nerve
Which nerve impairment results in trendelenburg’s sign
superior gluteal nerve (pelvis drops on supported side, gluteus minimus and medius are not working) (i.e. stand on L leg with L leg muscles hurt, R leg (uninjured) will drop).
Where do the femoral vessels leave the adductor canal, travel to the posterior thigh, and become the popliteal vessels?
At the adductor hiatus (in the distal thigh, between 2 insertions of adductor magnus ( Adductor tubricle for hamstring and gluteal tuberosity for adductor part)
Which nerve lies between the illiacus and psoas major muscles
The Femoral nerve
Which nerve injury causes foot drop
Deep fibular/peroneal nerve (Distal branch of sciatic n)
Where does the deep femoral artery branch from the femoral artery
in the femoral triangle (and then travels deep in thigh, posterior to adductor longus
Which artery provides collatoral circulation at the apex of the femoral triangle
descending branch of the lateral circumflex femoral
- It anastamoeses with the descending genicular branch of femoral artery and lateral sperior branch of popliteal
Which muscles and nerves are primarily responsible for hip abduction? Which are of lesser importance?
Superior gluteal nerve, supplying the Gluteus medius, gluteus minimus, and tensor fasciae late.
- Periformis, Obturator internus, Sup and inf gemelli abduct flexed hip (Also laterally rotate extended hip)
In respect to the adductor longus, which arteries run along it?
The Femoral artery is superficial to the adductor longus, the deep femoral artery( profunda femoris) is deep to the adductor longus
What artery supplies blood to the femoral neck
Medial circumflex femoral
Lateral circumflex femoral
( called cruciate anastamoses)
Which nerve provides cutaneous innervation to the medial side of the leg
The saphenous nerve
Which nerve provides cutaneous innervation to the skin of the posterior surface of the lower leg and lateral side of the foot
Lateral sural cutaneous nerve (off fibular nerve)
- When more in foot area, becomes superficial fibular nerve
What nerves does the common fibular nerve give rise to
lateral sural cutaneous nerve, superficial fibular nerve, deep fibular nerve
What vein does the lateral sural cutaneous nerve run directly next to
the lesser saphenous vein
Which nerve causes a pelvis dip on the ipsilateral side as weightbearing when injured?
Superior gluteal nerve (innervating gluteus medius and minimus)
The team doctor tells a football player that he has “a pulled hamstring” muscle. This results from a tearing of the origin of a hamstring muscle from the:
Ischial tuberosity
Where do the hamstring muscles insert
Tibia and fibula (biceps)
Innervations of hamstrings
Tibial of sciatic (common fibular (peroneal) for Short head of biceps)
If the head of the femur is dislocated postero-medially, compression of which nerve is likely to result?
Sciatic nerve ( If the sciatic nerve was completely paralyzed, the compartments innervated by its two branches: the common fibular and tibial nerves, would lose function. This would mean that the hamstrings and all the muscles of below the knee would lose their innervation.)
What muscle passes through the lesser sciatic foramen?
obturator internus
The femoral artery enters the popliteal fossa (becoming the popliteal artery) by passing through the:
Adductor hiatus
The short head of biceps femoris muscle is innervated by which nerve?
Common fibular nerve (all other hamstrings are tibial)
As a patient with paralyzed gluteus medius and minimus muscles on the left side attempts to stand on the left limb only, the right side of the pelvis typically:
Drops
What is the deepest structure in the popliteal fossa
Popliteal artery- if there was a femur fracture and it was dislocated posteriorly, could hurt popliteal artery
The deep femoral artery is the principle blood source for the muscles in which compartment of the thigh?
Posterior (hamstring)
The femoral artery is the principle blood source for the muscles in which compartment of the thigh?
the quadriceps (anterior compartment)
The obturator artery is the principle blood source for the muscles in which compartment of the thigh?
Medial compartment (Also supplied by medial circumflex and deep femoral)
Which arteries supply the gluteal region
superior and inferior gluteal arteries
A fracture of the ischial tuberosity might be expected to most directly affect the muscles that produce which lower limb movement?
Flexion at the knee
- Hamstrings muscles originate at ischial tuberosity
What are the most important hip abductors, and which nerve injury will impact them most?
Gluteus medius and minimus- superior gluteal nerve
What are the most important hip adductors
adductor longus, brevis, magnus
- insert on linea aspera, innervated by obturator nerve
When, in approximately 12% of people, the common fibular nerve passes through the piriformis muscle, the nerve may be compressed. This would affect part of which muscle?
The short head of the biceps femoris is innervated by the common fibular nerve ( peroneal nerve)
- The other hamstrings (semitendinous, semimembranous, biceps long head are innervated by the tibial nerve)
An elderly patient complains of difficulty in walking up stairs. Tests by her doctor reveal weakness in extension at her hip, but no change in hip flexion, or flexion or extension of the knee. Based upon these results, what muscle is most likely not functioning properly.
Gluteus maximus
- Extends thigh.
Not Semitendinosus because, although that extends thigh, it also flexes knee
Weakness in climbing stairs or jumping would indicate a lesion of which nerve?
Inferior gluteal
- Weakness in hip extension (gluteus maximus is pimary mover)
- Or, Tibial division of sciatic, Hamstrings extend hip
Which arteries supply the posterior compartment of the thigh
Perforating branches of deep femoral artery
Which muscles rotate the thigh laterally
Sartorius
Gluteus maximus
Obturator externus
Quadratus femoris
Periformis and Obturator internus and superior and inferior gemellus also do when the hip is extended
Which muscles rotate the thigh medially
Adductor longus and adductor brevis
pectinius
gluteus medius and gluteus minimus
tensor fasciate late
The hamstrings are supplied by which artery
deep femoral
What structures travel through the greater sciatic foramen, inferior to the periformis, lying in the posterior thigh?
Femoral nerve, sciatic nerve
Because of its muscle attachments, a fracture to the ischial tuberosity would affect which movement of the lower limb?
Flexion of the leg
- Hamstrings originate at the ischial tuberosity
What does the popliteal artery divide into and where do these arteries supply
Popliteal artery splits into posterior tibial artery ( and anterior tibial artery)
Femoral–>Popliteal at adductor canal
Where does great saphenous vein run (and where does it empty)
Ascends anteriorly to medial malleolus, posteriorly to medial epicondyle of the femur, and then empties into the femoral vein at the saphenous opening in the fasica lata
Where does the small saphenous vein run and where does it empty into
Ascends posterorly to the lateral malleolus, empties into popliteal vein in politeal fossa
Where does the great saphenous vein drain into the femoral vein
in the saphenous hiatus in the femoral triangle
What do the muscular, articular, and cutaneous branches of the femoral nerve service
Muscular: Anterior thigh
Articular: Hip and knee
Cutaneous: Anteromedial thigh
What is the terminal cutaneous branch of the femoral nerve and what does it innervate
Saphenous nerve- anteromedial knee, leg, and foot
If blood supply to the ascending branch of the lateral circumflex femoral artery is cut off, which artery will provide blood flow to the head of the femur?
Medial curcumflex femoral artery
If blood supply to the medial circumflex femoral artery is cut off, which artery will supply blood flow to the head of the femur?
Ascending branch of lateral circumflex femoral artery
Where does the anterior branches of the obturator nerve go
Anterior: cutaneous to middle part of medial thigh
Which anastomoses occur on the lateral side of the knee
Superior lateral geniculate artery and inferior lateral geniculate artery
Which anastamoses occur inferior to the patella to supply the knee
Inferior lateral giniculate artery, inferior medial geniculate artery
If blood supply to the descending branch of the lateral circumflex artery is cut off just proximally to the patella, which blood supply will take over?
The descending geniuclar artery (superior lateral genicular artery or superior medial genicular artery)
Which nerve provides cutaneous innervation to the dorsal of the foot and lateral ankle (distal anterior surface of leg, most of dorsum of foot)
superficial fibular (peroneal) nerve
Which nerve provides
cutaneous innervation right between the big toe and toe 2
Deep fibular/peroneal nerve
Which nerve provides cutaneous innervation to the anteriorly medial side of the leg
Saphenous nerve (from femoral nerve)
Which nerve provides cutaneous innervation to the lateral posterior side of the leg anteriorly
lateral sural cutaneous nerve
Where does the superifcial peroneal (fibular) nerve supply cutaneous innervation)
Distal anterior surface of leg, dorsum of foot.
Which nerve innervates extensor digitorum longus and extensor hallucis longus
Deep peroneal nerve
What does the deep peroneal/fibular nerve innervate
- Cutaneous to skin between big toe and toe 2
- Muscular to extensor digitorum longus, and extensor hallucis longus, peroneus tertius, Tibialis anterior
Insertion of plantaris
directly into calcaneus- not via calcaneal (achilles) tendon
Which muscles do adduction and which do abduction in the 4th foot layer
PAD, DAB
- Plantar interossei (3-5, 3 total) do adduction and flexion
- Dorsal interossei (1-4, 4 total) do abduction and flexion
What does the medial plantar nerve innervate
- 1st lumbrical
- Abductor hallucis
- Flexor digitorum brevis
- Flexor hallucis brevis
Which ligament is torn in the ankle with an inversion (most common type of) ankle sprain
Anterior talofibular ligament
- Injured during plantar flexion and inversion
What does the perineal nerve innervate
Bulbospongiosus muscle, ischiocavernosus, Posterior perineum
What artery lies posterior to the medial malleolus
Posterior tibial artery
- Tom Dick and Very Nauty Harry
- Tibialis posterior, Flexor digitorum longus, Posterior tibial artery and vein, Tibial nerve, Flexor hallucis longus
Which nerve is implicated in plantar fascitis
Lateral plantar nerve (off of Tibial nerve)
What does the dorsalis pedis artery arise from
Anterior tibial artery
Which nerve runs alongside the dorsalis pedis artery
deep fibular nerve
Do medial plantar and lateral plantar run on the dorsum or plantar of the foot
plantar
Which muscle abducts toes
Dorsal interosseous muscle, innervated by the lateral plantar nerve
Where does the dorsalis pedis artery lie in relation to the extensor hallucis longus muscle
The dorsalis pedis artery is lateral to the tendon of the extensor hallucis longus
Which nerves are responsible for dorsiflexion of the foot? Which are responsible for eversion?
Common fibular- innervates dorsiflexion w deep fibular ( Tibialis anterior, Extensor digitorum brevis, extensor hallucis longus), and innervates eversion with superficial peroneal/fibular ( Peroneus longus, Peroneus brevis)
Where is the flexor retinaculum and what structures are in it
Immediately posterior to medial malleolus
- STructures come from posterior leg to foot
- Tom, dick, and very naughty harry are under.
Which nerve is assocaited with foot drop and which associated muscles accompany this injury?
- Deep fibular/peroneal nerve
- Tibialis anterior, Extensor digitorum longus, Extensor hallucis longus.
Which nerve innervates everters of the foot and which muscles are these
- Superficial fibular/peroneal nerve, peroneus brevis/peroneus longus/peroneus tertis
A patient has been diagnosed with bone cancer in the fibula that necessitates its removal. Which of the following muscles would be least affected following removal of the fibula?
- biceps femoris
- extensor digitorum longus
- flexor digitorum longus
- flexor hallucis longus
-peroneus tertius
Flexor Digitorum longus
- Biceps inserts on fibula
- Flexor hallucis longs originates from fibula
- Fibularus/peroneus longus and brevis originate on fibula
One of the menisci of the knee is often injured in a sprain of the knee because which minisci is attached to which tendon
Medial collateral ligament (sometimes called Tibial collateral ligament) is attached to the medial meniscus
In an auto accident, the patient’s knee strikes the dashboard which in turn pushes the head of the femur posteriorly out of its socket. Which ligament is most likely ruptured by this posterior dislocation?
ischiofemoral
- The iliofemoral ligament forms the anterior wall of the hip capsule, the pubofemoral lies beneath the joint, and the ischiofemoral ligament forms the posterior free margin of the hip capsule.
Which ligament is injured in an eversion ankle sprain
deltoid ligamnent (attaches medial malleolus with talus, navicular, and calcaneous)
Which ligament limits extension at the hip joint?
Iliofemoral
The extension of the vaginal lumen around the intravaginal part of the uterine cervix is the:
Fornix
Which nerve would be most likely to be damaged by a stab wound into the ischiorectal (ischioanal) fossa 2 cm lateral to the anal canal?
Pudental nerve
Under normal conditions, fertilization occurs in which part of the female reproductive tract?
Ampulla of uterine tube
The shaft of the penis is to what in the female reporductive tract
the shaft of the clitoris
What are the boundaries of the trigone of the bladdar
Ureteric orifices, urethral orifice, interuteric crest
Which structure is found only in males?
-Anterior recess of ischoianal fossa
-Genital Hiatus
-Ischiocavernosus muscle
-Rectovesical pouch
-Sphincter urethrae muscle
Retrovesicular pouch
Which male structure travels through the prostate and opens into the prostatic urethra
Ejaculatory duct
In females, which structure is directly anterior to the rectum
the cervix
What are the lobes of the prostate
Anterior, posterior, lateral, middle
Which of these features of the anal canal serves to indicate the point where the mucosal covering of the gastrointestinal tract ends and a skin-like covering begins?
Pectinate line
The expanded region of the lower rectum, where fecal matter is retained, is known as the:
Ampulla
Which artery anastamoses with the uterine artery
ovarian artery
During a hysterectomy and an oophorectomy, the uterine and ovarian vessels must be ligated. These vessels can be found in which ligaments?
The uterine vessels are found in the inferior portion of the broad ligament, while the ovarian vessels are found in the suspensory ligaments of the ovaries.
What vessel contains the uterine vessels
the inferior portion of the broad ligament
What vessel contains the ovarian vessels
suspensory ligaments of the ovaries
You suspect that your patient suffers from benign prostatic hypertrophy, which causes enlargement of the __________ of the bladder.
Uvula
The part of the broad ligament giving attachment and support to the uterine tube is the:
Mesosalpinx
Which skeletal feature would you consider to be most characteristic of the female pelvis?
Subpubic angle of 90 degrees or greater
Marked anterior curvature of the sacrum
Tendency to vertical orientation of the iliac bones
Prominent medial projection of the ischial spines
There are four major differences between the male and female pelvis. First, the subpubic angle and pubic arch are greater in the female pelvis than in the male pelvis. This is why A is correct– females often have a subpubic angle of 90 degrees or greater. A second difference between the female and male pelvis is that the pelvis inlet for females is rounded, while for males it is heart shaped. Third, the pelvic outlet for females is larger than in males. Finally, the female pelvis has iliac wings that are more flared than in males.
You are observing a doctor perform an abdominal hysterectomy. He notes that it is vital to protect the ureter which is found in the base of the:
mesometrium
mesovarium
mesosalpinx
round ligament of the uterus
suspensory ligament of the ovary
Mesometrium
- Mesometrium attaches the uterus to the pelvic wall and the ureters pass through the mesometrium to reach the bladdar
Following pregnancy and delivery, a 32-year-old woman continued to have problems with urinary incontinence which developed during pregnancy. Her obstetrician counseled her to strengthen the muscle bordering the vagina and urethra, increasing its tone and exerting pressure on the urethra. This physical therapy was soon adequate to restore urinary continence. What muscle was strengthened?
puborectalis
Puborectalis is the part of levator ani that is closest to the vagina and urethra. This muscle may be injured during a difficult childbirth.
Preganglionic parasympathetic nerve fibers within the pelvic (inferior hypogastric) plexus arise from S2, 3, 4 and enter the plexus via:
pelvic splanchnic nerves
Which structures are where postganglionic sympathetic neurons travel to get out of the sympathetic trunk and rejoin a spinal nerve
The grey rami communicantes
- structures that postganglionic sympathetic neurons travel on to get out of the sympathetic trunk and rejoin a spinal nerve.
While performing a hysterectomy, the resident must ligate the uterine artery. To avoid iatrogenic injury to the ureters, she must be aware that the ureter passes ___________ the artery at the level of the ______________.
Under, Cervix
A caudal epidural block is a form of regional anesthetic used in childbirth. Within the sacral canal, the anesthetic agent bathes the sacral spinal nerve roots which would anesthetize all of the following nerves except:
Pelvic splanchnics
Pudendal
S2 dorsal root
Sacral splanchnics
S2 ventral primary ramus
Sacral splanchnics
these areise from the sacral sympathetic ganglia
A patient presents complaining of blood-stained stools and the inability to completely empty his rectum. He also has pain along the back of his thigh and weakness of the posterior thigh muscles. Digital examination reveals a tumor in the posterolateral wall of the rectum. Pressure on what nerve plexus could cause the pain in his lower limb?
Sacral nerve plexus
Supplies motor innervation to pelvic diaphragm, urogeital diaphragm, and posterior hip, thigh, leg, and foot ( Superior gluteal, pudental, sciatic nerves all come from here)
In a patient with rectal cancer located in the wall of the ampulla, you find that the cancer has spread to the muscle immediately lateral to the ampulla. This muscle is the:
Levator ani
Blood supply to the superior portions of the bladder typically arises from the ____________ arteries.
umbilical
The pelvic splanchnic nerves primarily carry ____________ to the _____________ plexus.
preganglionic parasympathetics–inferior hypogastric
The arcus tendineus levator ani is a thickening of fascia of the:
Obturator internus
What are the boundaries of the perineum
Anterior: pubic symphysis; Anterolateral: ischiopubic rami; Lateral: ischial tuberosities; Posterolateral: sacrotuberous ligament; Posterior: tip of the coccyx
A condensation of fibrous tissue in the female located at the center of the posterior border of the perineal membrane is the:
Perineal body
- an irregular fibromuscular mass located at the center of the posterior border of the perineal membrane
The artery which supplies blood to the major erectile body in both the male and female is the:
Perineal artery
- Deep artery of penis/clitoris in some versions
The vestibular bulbs/bulb of the corpus spongiosum are firmly attached to the:
perineal membrane
- Covered by bulbospongiosus muscle
The part of the male reproductive tract which carries only semen within the prostate gland is the:
Ejaculatory duct
- Semen is the combination of sperm from the ductus deferens, seminal fluid from the seminal vesicle, and secretions of the prostate gland.
During childbirth a bilateral pudendal nerve block may be performed to provide anesthesia to the majority of the perineum and the lower one fourth of the vagina. To do this an anesthetic agent is injected near the pudendal nerve as it passes from the pelvic cavity to the perineum. The physician inserts a finger into the vagina and presses laterally to palpate what landmark?
When performing a transvaginal pudendal nerve block, the ischial spine is palpated through the wall of the vagina and the needle is then passed through the vaginal mucous membrane toward the ischial spine. Eventually, the needle pierces the sacrospinous ligament, at which point the pudendal nerve is bathed with anesthetic. Remember–the pudendal nerve is within the pudendal canal, and it wraps around the ischial spine before it delivers its branches. So, administering the nerve block at the ischial spine allows a physician to anesthetize all the branches of the pudendal nerve. This is a very important landmark that you want to remember!
During a prostatectomy, the surgeon attempts to protect the prostatic plexus of nerves which contains nerve fibers that innervate penile tissue to cause erection. From which nerves do these fibers originate?
Pelvic splanchnics
- Erection is mediated by parsympathetic nerves, and pelvic splanchnic nerves are the ones that innervate pelvic viscera
Which muscles laterally rotate the thigh
Sartorius
Quadratus femoris
Gluteus maximus
Obturator externus
Where does the pudental nerve travel
Exits through the greater sciatic foramen, back into the pelvis through lesser sciatic foramen
Where does sciatic nerve arise from
S1-S3
What muscle lies behind sciatic nerve
periformis
Where nerve does the pudental go into distally
into the perineal nerve
Which nerve controls the bulbospongiosus, external urethral and anal sphincters, levator ani, and ischiocavernosus
pudenta (motor and sensory)
What is the sympathetic pathway for the hindgut
Lateral horns of spinal cord–>Sympathetic chain–>Inferior mesenteric–>Hindgut
What is the sympathetic pathway for the sacral ganglion
Sacral ganglion–>Sacral splanchnic–>Inferior hypogastric–>External genitalia/bladdar/prostate
What happens to the rectum/bladdar/sphincters in sympathetic activation
Rectum: Decreases movement of food
Interal sphincters: Contract so food doesn’t move
Bladder: Relax so pee isnt pushed out
What happens to the penis and uterus during sympathetic activation
Penis: Ejaculate- contract vas deferens and seminal vesicles
Uterus: Relax and contract depending on hormones being activated
Arteries vasoconstrict
Describe the parasympathetic innervation of the pelvis
Sacral origin from S2-S4
Pelvic splanchnic nerves
–>synapsing occurs at effector organ (i.e. on rectum)
Does sympathetic or parasympathetic have long postganglionic fibers
Sympathetic has long (parasympathetic synapses directly on organ)
What occurs with the rectum, anus, sphincters, bladder during parasympathetic activaton
Rectum/Anus: Contract to let out motile food
Sphincters: Relax internal anal sphincter
Bladder: Contracts detrusor and relaxes internal sphincter to expel urine
Does sympathetic or parasympathetic cause erection vs ejaculation
Parasympathetic- erection
Sympathetic- Ejaculation
What are the branches of the posterior division of the internal iliac
Lateral sacral and superior gluteal
