TOPIC 4- LOWER EXTREMITY

Question 1

How many layers of muscles of gluteal region do you know?

Answer 1

a. Under the deep fascia the muscles are located within the the gluteal region
b. These are three layers of muscle

Question 2

Name muscles composing first layer of the gluteal region

Answer 2

First layer of muscles consists of gluteus maximus muscle and upper part
of gluteus medius muscle.
b. The succession of the muscles of second layer from above downward
include the lower part of gluteus medius, piriformis, obturator internus
with the gemelli muscles and quadratus femoris.

Question 3

Name muscles composing third layer of gluteal region.

Answer 3

third layer of muscles consists of two muscles known as superiorly the
gluteus minimus and inferiorly the obturator externus.

Question 4

Name peculiarities of inferior deep fascia of the gluteal region and gluteus
maximus muscle.

Answer 4

The deep fascia is attached superiorly to the iliac crest, laterally to the
iliotibial tract and continues inferiorly as the fascia lata. It splits to
enclose the gluteus maximus by two layers.

Question 5

By what are the greater sciatic notch and lesser sciatic notch divided into
foramina?

Answer 5

Greater sciatic foramen is formed by the conversion of the greater
sciatic notch of the hip bone into a foramen by the presence of the
sacrotuberous and sacrospinous ligaments. b. Lesser sciatic foramen is formed by the conversion of the lesser sciatic
notch of the hip bone into a foramen by the presence of the sacrotuberous
and sacrospinous ligaments

Question 6

What structures pass through lesser sciatic foramen?

Answer 6

The following structures pass through the foramen: tendon of obturator
internus muscle, pudendal nerve, internal pudendal artery and vein.

Question 7

Into what two small foramina does the piriformis muscle passing through
greater sciatic foramen divided it above and below?

Answer 7

The piriformis muscle passing through greater sciatic foramen divides it
and forms two small foramina, above is the suprapiriformis and below is
the infrapiriformis

Question 8

By what is the suprapiriformis foramen limited superiorly and inferiorly?

Answer 8

a. The suprapiriformis foramen is limited superiorly by the inferior border
of gluteus medius muscle and inferiorly by the superior border of the
piriformis muscle.

Question 9

By what is the infrapiriformis foramen limited superiorly and inferiorly?

Answer 9

The infrapiriformis foramen is limited superiorly by the inferior border of
piriformis muscle and inferiorly by superior border of the sacrospinous
ligament.

Question 10

Between what is the fat space of the gluteal region located posteriorly (or
superficially) and anteriorly (or deeply)?

Answer 10

The fat which is located between the gluteus maximus muscle (anteriorly)
and second layers of the muscles (posterior) (that is under gluteus
maximus muscle) surrounds vessels and nerves. b. First layer of muscles consists of gluteus maximus muscle and upper part
of gluteus medius muscle. The succession of the muscles of second layer
from above downward include the lower part of gluteus medius, piriformis, obturator internus with the gemelli muscles and quadratus femoris.

Question 11

With what is the fat space of the gluteal region communicated

Answer 11

a. Pelvic fat through the infrapiriformis foramen along vessels and nerves
b. Fat of ischiorectal fossa through lesser sciatic foramen along pudendal
nerve and internal pudendal vessels
c. Fat of posterior region of the thigh along sciatic nerve (pus may reach to
popliteal fossa)
d. Fat of adduction compartment of the thigh along posterior branches of
the obturator artery which pass between obturator externus muscle, and
quadratus femoris muscle and anastomose with inferior gluteal artery.

Question 12

By what is the muscular lacuna limited anteriorly, posteriorly and laterally, medially?

Answer 12

a. Anteriorly
i. By the inguinal ligament
b. Posteriorly & laterally
i. By the ilium
c. Medially
i. By the iliopectineal arch or ligament

Question 13

What following structures pass through muscular lacuna?

Answer 13

a. Muscular lacuna contains the iliopsoas muscle, femoral nerve, lateral
femoral cutaneous nerve.

Question 14

Name clinical importance of the muscular lacuna.

Answer 14

Tuberculous disease of the thoracolumbar region of the vertebral column
results in the destruction of the vertebral bodies, with possible ex-tension
of pus laterally under the psoas fascia. From here, the pus tracks
downward, following the course of the psoas muscle, and appears as a
swelling in the upper part of the thigh below the inguinal ligament. The
psoas abscess passes through muscular lacuna. It may be mistaken for a
femoral hernia.

Question 15

By what is the vascular lacuna limited anteriorly, posteriorly, medially and
laterally?

Answer 15

a. Anteriorly
i. By inguinal ligament
b. Posteriorly
i. By pectineal ligament
c. Laterally
i. By iliopectineal arch
d. Medially
i. By the lacunar ligament

Question 16

Name the syntopy of the vessels passing through vascular lacuna.

Answer 16

a. The vein is medially while the artery is laterally. Medially to the vein is a
space that is located known as femoral ring of the vascular lacuna.

Question 17

What does the vascular lacuna transmit medially and laterally?

Answer 17

a. Vascular lacuna transmits femoral vessels
i. Medially
1. Vein
ii. Laterally
1. Artery
iii. The femoral artery and vein are surrounded by femoral sheath

Question 18

By what is the femoral ring bounded anteriorly, posteriorly, medially and
laterally?

Answer 18

a. Anteriorly
i. By the inguinal ligament
b. Posteriorly
i. By the pectineal ligament
c. Medially
i. By the lacunar ligament
d. Laterally
i. Femoral vein

Question 19

What form have femoral canal?

Answer 19

The femoral fossa is located on the parietal peritoneum of the posterior
surface of the abdominal wall, below the inguinal ligament and opposite
the femoral ring. The peritoneum may be pushed or drawn through the
femoral ring to form a femoral hernia. The femoral hernia passes through
the femoral canal. The femoral canal has the triangular form

Question 20

By what is the femoral canal limited anteriorly, posteriorly and laterally?

Answer 20

a. Anteriorly
i. By the falciform margin of the fascia lata (or superficial layer of
fascia lata)
b. Posteriorly & medially
i. By the pectineal fascia (or deep layer of fascia lata)
c. Laterally
i. By the sheath of the femoral vein

Question 21

With what does the fat occupying of the femoral ring communicate upward and
downward?

Answer 21

The femoral ring is filled with fat that communicates with the
extraperitoneal fat of anterior abdominal wall upwards with the fat of
the femoral triangle downwards

Question 22

What is superficial ring of femoral canal?

Answer 22

The saphenous opening or oval fossa is superficial ring of femoral canal.

Question 23

By what is the saphenus opening limited?

Answer 23

The falciform margin of fascia lata limits the saphenous opening.

Question 24

By what is the femoral triangle limited medially, laterally and superiorly?

Answer 24

a. Medially
i. By the medial border of adductor longus muscle
b. Laterally. i. By the medial margin of the sartorius muscle
c. Superiorly (base)
i. By the inguinal ligament

Question 25

By what muscles is the floor of the femoral triangle formed?

Answer 25

a. By pectineus muscle and iliopsoas muscle

Question 26

Name the syntopy of femoral neurovascular bundle under the inguinal ligament
from medially to laterally.

Answer 26

Medially
i. By the femoral artery, femoral vein and femoral canal
b. Laterally
i. By the femoral nerve

Question 27

Enumerate the superficial branches of the femoral artery

Answer 27

Superficial epigastric artery, superficial circumflex iliac artery and the
external pudendal artery

Question 28

How many groups of inguinal lymph nodes do you know?

Answer 28

a. Two groups (the superficial nodes and deep nodes)

Question 29

Name groups of inguinal lymph nodes.

Answer 29

Superficial nodes-lie immediately below inguinal ligament and alongside
the great saphenous vein
b. Deep nodes-lie alongside femoral vein

Question 30

By what is the adductor canal bounded laterally, medially and posteriorly, anteriorly?

Answer 30

Laterally
i. By the vastus medialis
b. Medially & posteriorly
i. By the adductor magnus
c. Anteriorly
i. By the vastoadductoria lamina

Question 31

Name foramens of the adductor canal.

Answer 31

The Superior, inferior and anterior foramens

Question 32

What structures pass through anterior foramen of the adductor canal?

Answer 32

A descending genicular artery, branch of femoral artery and the
saphenous nerve leave the adductor canal through the anterior foramen

Question 33

By what is the extensor compartment of the thigh limited anteriorly, medially
and laterally?

Answer 33

a. Anterolaterally
i. Fascia lata

Question 34

By what is the obturator canal formed superiorly and inferiorly?

Answer 34

a. Superiorly
i. By the obturator groove of superior ramus of pubic bone
b. Inferiorly
i. By the obturator membrane, obturator internus and externus
muscles

Question 35

Enumerate in succession layers covering the sciatic nerve at gluteal fold.

Answer 35

a. between the lower border of gluteus maximus and the long head of biceps
femoris the sciatic nerve lies under fascia lata (skin, subcutaneous tissue
and fascia lata)
b. Below of this small part it is covered by the long head of biceps femoris
and then it passes between muscles semitendinous and semimembranous
medially and the biceps femoris – laterally, until it appears at the apex of
the popliteal fossa.

Question 36

With what does the fat surrounding the sciatic nerve communicate superiorly, inferiorly, anteriorly?

Answer 36

a. Superiorly
i. By the fat space of gluteal region
b. Inferiorly
i. By the fat of popliteal fossa
c. Anteriorly
i. By the fat of medial fascial compartment along the perforating
branches of profunda femoris artery

Question 37

Enumerate in succession layers covering the common peroneal nerve on lateral
surface of the knee joint.

Answer 37

The common peroneal nerve is found beneath the lateral border of the
fossa which is formed by biceps femoris. It follows this muscle toward the
head of the fibula.

Question 38

Name structures locating anterior to patella.

Answer 38

a. Anteriorly, the quadriceps tendon is inserted into the patella. Anterior
knee region contains synovial bursae which are disposed nearly places of
attachment of tendons. b. Prepatellar bursae (subcutaneous, subfascial and subtendinous)

Question 39

Name structures locating below patella at level tuberosity of tibia

Answer 39

Below the patella at the level tuberosity of the tibia are two infrapatellar
bursae
i. The subcutaneous infrapatellar bursa which is over the patellar
ligament)
ii. The deep infrapatellar bursa which is located between patellar
ligament and tuberosity of tibia)

Question 40

By what is the popliteal fossa bounded

Answer 40

The upper lateral border is formed by biceps femoris muscle
b. The upper medial border is formed by semimembranosus and
semitendinosus

Question 41

By what is the floor of the popliteal fossa formed?

Answer 41

The posterior aspect of the lower end of the body of the femur
b. The oblique popliteal ligament
c. The popliteus muscles

Question 42

Name the syntopy of vessels and nerve of popliteal fossa from back to
forwards.

Answer 42

a. Posteriorly or superficially
i. By the tibial nerve
b. Anteriorly or deeply & medially
i. By the popliteal vein
c. More anteriorly or deeply & more medially
i. By the popliteal artery

Question 43

Name the syntopy of vessels and nerve of popliteal fossa from laterally to medially

Answer 43

Laterally & Medially
i. Medial head of gastrocnemius

Question 44

state the anatomical structure of neurovascular bundle adjoin to floor of
popliteal fossa.

Answer 44

Floor of the popliteal fossa forms the planum popliteal of the femur, capsule of the knee joint, popliteal muscle and capsule of the knee joint

Question 45

With what does the fat of the popliteal fossa communicate?

Answer 45

With fat of posterior fascial compartment of the thigh
b. With fat of femoral triangle
c. With fat of posterior fascial compartment of the leg