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MSK 2 > Weak Topics > Flashcards

Weak Topics Flashcards

1
Q

What does the quadriceps tendon do?

A

attaches all four parts of the quadriceps femoris muscle to the patella

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2
Q

Where does the patella ligament run?

A

patella to tibial tuberosity

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3
Q

Patient presents with numbness, tingling, and burning sensations in the lateral aspect of right upper thigh, exacerbated by pressure to ASIS. What nerve is affected? What is the condition called? What conditions/factors aggravate the situation?

A
  • meralgia paresthetica
  • entrapment of the lateral femoral cutaneous nerve as it passes under the inguinal ligament in proximity to the ASIS
  • Weight gain (ex: pregnancy) and nerve entrapment from tight undergarments or belts
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4
Q

Pt presents with painful swelling over bilateral patella after kneeling regularly for his job. Swelling is fluctuant, directly superficial to the patellae, and there does not appear to be a knee joint effusion. What is the diagnosis?

A

prepatellar bursitis

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5
Q

What muscle may be innervated by the femoral or the obturator nerves?

A

Pectineus
-Owing to its location, straddling the anterior and medial compartments of the thigh, the pectineus may be innervated by either the femoral or obturator or both nerves.

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6
Q

What muscle should be targeted to prevent lateral femoral dislocation?

A

vastus medialis m

  • inserts into the patella and the tibial tuberosity through the common quadriceps tendon and patellar ligament
  • extend the leg at the knee joint, but it also maintains a medial pull on the patella, reducing the lateral, dislocating force
  • patella is stabilized by the vastus medialis muscle and the prominent femoral condyles, which usually prevent lateral dislocation during flexing of the leg at the knee joint
  • stabilize the patella within the patellar groove to control the tracking of the patella when the knee is bent and straightened
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7
Q

What are the 4 components of the Cruciate Anastomosis?

A
  1. 1st Perforating Branch of deep femoral a.
  2. Medial circumflex femoral a.
  3. Lateral circumflex femoral a.
  4. Inferior gluteal a.
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8
Q

What are the 5 components of the Genicular Anastomosis?

A
  1. Lateral femoral circumflex a, descending branch
  2. Descending genicular a.
  3. Superior and inferior lateral genicular a
  4. Superior and inferior medial genicular a
  5. Middle genicular a.
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9
Q

What can happen to long time horseback riders?

A

firm but not painful “swellings” in his right anteromedial thigh due to ossification of adductor muscle tendon because of constant contraction

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10
Q

Where are the iliac tubercles located?

A

At the widest point of the iliac crest, 5-6 cm posterior to the anterior superior iliac spines

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11
Q

What are the components of the femoral triangle?

A

..

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12
Q

What are the components of the adductor canal?

A

…

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13
Q

What goes through the greater sciatic foramen?

A

…

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14
Q

What goes through the lesser sciatic foramen?

A

…

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15
Q

What 3 muscles attach to the ASIS?

A
  1. Tensor Fascia Lata m.
  2. Sartorius m.
  3. Rectus Femoris, straight head
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16
Q

What is the presentation for a hip dislocation?

A

instability and limited ABduction of joint and leg shortening with asymmetry of gluteal folds

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17
Q

Flexor hallucis longus is important for what action? Where is it’s pulley system?

A

Normal gait

-on talus: groove for flexor hallucis longus and sestentaculum tali on calcaneus also assists (holds up talus)

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18
Q

What 3 bones does the navicular bone articulate with?

A
  1. talus head (posterior)
  2. 3 cuneiforms (anterior)
  3. cuboid (lateral)
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19
Q

What 5 muscles provide dynamic support for foot?

A
  1. Tibialis posterior
  2. Tibialis anterior
  3. Flexor hallucis longus
  4. Fibularis longus
  5. Intrinsic plantar muscles
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20
Q

What 4 things do structures in the same structural compartment share?

A
  1. general function
  2. nerve
  3. artery
  4. vein
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21
Q

What does the anterior thigh compartment contain?

A
  1. femoral n

2. extensors @ knee

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22
Q

what compartments does the anterior septum separate?

A

anterior and lateral thigh

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23
Q

what compartments does the interosseous membrane separate?

A

anterior and deep posterior thigh

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24
Q

what compartments does the transverse septum separate?

A

deep and superficial posterior

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25
Q

what compartments does the posterior septum separate?

A

lateral and superficial posterior

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26
Q

What does the medial thigh compartment contain?

A
  1. muscles that adduct hip

2. obturator n.

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27
Q

What does the superficial posterior thigh compartment contain?

A
  1. gastrocnemius (triceps surae)
  2. soleus (triceps surae)
  3. plantaris m.
  4. sciatic n.
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28
Q

What does the deep posterior thigh compartment contain?

A
  1. popliteus
  2. flexor hallucis longus
  3. flexor digitorum longus
  4. tibialis posterior
  5. tibial and posterior tibial n.
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29
Q

Pes anserinus muscles

A
  1. sartorius
  2. gracilis
  3. semitendinosus
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30
Q

What is the adductor hiatus?

A

opening b/t aponeurotic distal attachment of adductor part of adductor Magnus and distal attachment of hamstring part

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31
Q

What does the adductor transmit?

A

femoral a and v from adductor canal in thigh to popliteal fossa

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32
Q

What is the base of the femoral triangle?

A

inguinal ligament

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33
Q

How can you palpate the femoral triangle in alive patients?

A

inferior to inguinal ligament when thigh is flexed, abducted, and laterally rotated

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34
Q

what makes up the medial and lateral borders of the femoral triangle?

A

medial: adductor longus
lateral: sartorius

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35
Q

what makes up the muscular floor of the femoral triangle?

A

iliopsoas laterally and pectinous medially

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36
Q

what forms the roof of the femoral triangle?

A

fascia lata, cribriform fascia, sub cut tissue, skin

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37
Q

Compression at which point will reduce blood flow through the femoral artery and branches?

A

pressing posterior against superior pubic ramus, posoas major, and femoral head

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38
Q

What would be a concern for anterior thigh wounds?

A

femoral a and v laceration, artery lies superficial in femoral triangle

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39
Q

Differential for lump in femoral triangle

A
  1. femoral hernia
  2. Saphenous varies
  3. Psoas abscess
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40
Q

What sites are common for an avulsion fracture of hip?

A

ASIS, AIIS, Ischial tuberosity, ischiopubic ramus

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41
Q

Why is the femoral neck most commonly fractures?

A

narrowest, weakest, and angle to line of weight bearing (pull of gravity)

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42
Q

What location is most concerning with a femur fracture?

A

inferior/distal location because it separates condyles and opportunity to misalign so compromises blood supply to leg

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43
Q

What types of femur fractures result from indirect (ex:stumbling on curb) trauma?

A

proximal fractures: transvervical (middle neck) or intertrochanteric

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44
Q

What type of femoral fractures typically result from direct trauma?

A

greater trochanter and femoral shaft

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45
Q

What tibial site is most common for compound fractures?

A

shaft

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46
Q

What tibial site is most common for general fracture

A

middle and inferior thirds b/c its the narrowest (also has poorest vascularization so poor healing)

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47
Q

What types of fractures are common in people who take long hikes before they are conditioned?

A

transverse march stress fractures of tibia

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48
Q

Osgood Schlatter

A

fracture that disrupts epiphyseal plate at tibial tuberosity

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49
Q

A skiing incident where one falls forward at high speeds is most likely producing what type of fracture?

A

“boot top fracture”

diagonal fracture of tibial shaft from eversion, which can also result in fibular fracture (presents as shortened leg)

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50
Q

What type of fracture is common with excessive inversion

A

fibular fx: ankle ligament tears and tilt talus against lateral malleolus and can sheer off fibia

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51
Q

What type of fracture is common after a hard fall on heel? What joint would this disrupt?

A
  • calcaneus fracture resulting in shattering to several pieces (comminuted fracture)
  • Subtalar (talocalcaneal) joint
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52
Q

What type of fracture is common with severe dorsiflexion (person presses really hard on brake during crash)?

A

talar neck fracture- commonly dislocates posteriorly

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53
Q

What type of fracture is common when a heavy object falls on foot?

A

metatarsal fracture

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54
Q

Dancer fx

A

dancer loses balance and outs full weight on metatarsal = metatarsal fx

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55
Q

What type of fracture could happen with prolonged walking?

A

transverse fracture of metatarsals

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56
Q

What type of fracture is common with basketball and tennis players who sprain their ankle? (sudden inversion)

A

avulsion fx of 5th metatarsal from tendon of fibularis braves m

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57
Q

What might present between talus and calcaneus if there is failure in secondary ossification centers? What type of people is this common in?

A

Os trigonum

-Dancers and soccer players

58
Q

What type of injury can result in a crushing injury and is associated with the tendon of the flexor hallucis longus m?

A

sesamoid bone (head of 1st metatarsal)

59
Q

What type of injury is common in muscle overuse, blunt trauma, and secondary to burn injury? What would be the symptoms?

A

Compartment syndrome- inflammation, edema, hemorrhage

60
Q

What can happen to sites distal to compartment syndrome and what are the signs to look out for?

A

distal structures can become ischemic or permanently injured - loss of pulse, decreased tissue temp

61
Q

What happens with blood flow in varicose veins

A

great saphenous becomes dilated or rotated so cusps of valves don’t correctly close = result is inferior blood flow

62
Q

Which veins commonly become varicose?

A

great saphenous v and tributaries

63
Q

Causes of venous stasis?

A
  1. incompetent fascia (fails to resist muscle expansion)
  2. external pressure on veins such as during hospital stay
  3. muscular inactivity
64
Q

thrombophlebitis

A

inflammation around involved veins (such as during DVT)

65
Q

What cardiac procedure are great saphenous veins commonly used for? How does this work?

A

coronary arterial bypass, vein is inverted so valves open same way as arteries

66
Q

Why are great saphenous veins commonly used for coronary arterial bypasses?

A
  1. accessible
  2. decent harvest length b/c distance b/t tributaries and perforating branches
  3. walls have more elastic and muscular fibers
  4. circulation complications are more rare
67
Q

Where can the great saphenous vein be found in a saphenous cutdown?

A

skin incision anterior to medial malleolus

68
Q

What clinical scenario would saphenous cutdown be useful in?

A

insert cannula for prolonged administration of drugs, blood, plasma, and electrolytes

69
Q

What is a complication of saphenous cutdown and what would be the presentation?

A

ligation of saphenous n. - pain or numbness to medial border of foot

70
Q

Pt presents with lymphedema of the superficial inguinal lymph nodes, what are possible areas of infection? What is an extra concern in female patients?

A

perineum and entire lower limb b/c they drain entire trunk inferior to umbilicus
-metastatic uterine cancer b/c uterine fungus drains lymph into inguinal lymph nodes

71
Q

If you are trying to block the femoral nerve, where would you insert to lidocaine? What nerve roots would this affect? What would be the effect if done correctly?

A
  • L2-4
  • block 2 cm inferior to inguinal ligament, “finger breadth lateral to femoral a”
  • tingling, burning, and numbness (paresthesia) radiating down knee over medial side (if saphenous n. is affected)
72
Q

What is a hip pointer? What is its typically mechanism?

A

Contusion of iliac crest and avulsion of bony muscles attaching to iliac crest

73
Q

What muscles are commonly injured/affected in a hip pointer injury

A
  • Sartorius (attaches to ASIS)
  • Rectus Femoris (attach to AIIS)
  • Hamstring muscles (semitendinosus, semimembranosus, biceps femoris b/c they attach to ischium)
74
Q

What is the most common site for a charley horse (thigh hematoma)?

A

quadriceps (usually tendon of rectus femoris m.)

75
Q

What fascias combine to make up fascia covering of psoas major m?

A

transversalis fascia (internal abd wall) and psoas fascia

76
Q

What should be your differential for edema occurring in proximal, medial thigh?

A
  • lymphedema indicating infection
  • indirect or direct hernia
  • saphenous varix
  • psoas abscess from pyrogenic infection migrating via fascia from internal abd wall
77
Q

What would weakness to vastus medialis and vastus lateralis cause?

A

abnormal patellar movement and loss of joint stability

78
Q

Injury of femoral n cause? Describe their gait.

A
  • paralysis of quadriceps so inability to extend leg
  • Common gait: 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
79
Q

What is softening of the patellar cartilage called and common mechanism? (include specific population)

A

Chrondromalacia patella

  • marathon runners from over stressing knee (also basketball)
  • blow to the patella or extreme flexion of the knee
80
Q

What is a bipartite or tripartite patella?

A

different ossification centers fail to fuse patella into a single bone, so can sometimes be confused with fracture but THIS HAPPENS BILATERALLY

81
Q

What reflex can check the integrity of the femoral n? What would an abnormal patella reflex potentially indicate?

A

Patella tendon reflex

-lesion interrupting innervation of quad (peripheral VD)

82
Q

What are gracilis transplants commonly used for?

A

muscle in hand or external anal sphincter but you have to transplant nerve and blood vessels

83
Q

A patient presents with an injury after playing hockey and now has pain to the medial anterior thigh, what are your concerns?

A

injury to adductor longus m. because injury is common in fast accelerating, decelerating, and sports that frequently change direction

84
Q

Ossification of what tendon is commonly referred to as “riders bone”?

A

Adductor longus

85
Q

How would one palpate the femoral pulse?

A

between ASIS and pubic symphysis

86
Q

Where can one compress the femoral a via palpation/direct pressure?

A

pressing posteriorly against superior pubic ramus, posts major, and femoral head

87
Q

What clinical procedures is the femoral artery commonly used for?

A

LEFT cardiac angiography, coronary arteriography, and blood gas analysis

88
Q

Describe the process of cannulation?

A

happens inferior to inguinal ligament where catheter is inserted into LEFT femoral artery where it reaches the aorta to left ventricle for LEFT CARDIOANGIOGRAPHIES

89
Q

Patient presents with a laceration to anterior thigh and is bleeding profusely, what artery are you concern was cut?

A

femoral artery because it lies superficial

90
Q

What is a Saphenous Varix and what is its clinical presentation?

A

localized dilation of terminal great saphenous v which can cause edema in femoral triangle

91
Q

What vascular source is used for a right cardiac angiology?

A

Femoral being - catheter inserted and passes superiorly to IVC into right atrium

92
Q

4 areas that the deep fibular N supplies?

A
  1. anterior compartment muscles
  2. ankle and metacarpal phalangeal joints
  3. dorsal intrinsic foot muscles
  4. skin b/t digits 1 & 2
93
Q

What landmarks demarcates division of tibial N to anterior and posterior arteries?

A

tibial tuberosity

94
Q

What fascia does the lateral compartment lie between?

A

anterior and posterior crural septa

95
Q

What is contained in the lateral leg compartment?

A
  1. fibularis brevis m.
  2. superficial fibular n
  3. Fibularis longus m.
    * only compartment without distinct arterial branch accompanying nerve (fibular artery = largest branch of posterior tibial a.)
96
Q

Where does the superficial fibular n. begin? Where’s its path?

A

between fibularis longus and fibula

-extends b/t fibular muscles and lateral to EDL

97
Q

What areas does the superficial fibular n supply?

A
  1. anteroinferior leg
  2. nearly entire dorsal foot
  3. most dorsal aspect of digits
98
Q

Injury to what could result in paralysis of all anterior and lateral crural muscles, commonly known as “foot drop”?

A

Common fibular n (L4-S2)- winds around fibular head so most commonly injured lower extremity nerve

99
Q

Patient presents with high-stepping, waddling or “swinging-out” gait, what muscles movements do they have difficulty with and what nerve is affected?

A
  • dorsiflexion and eversion

- common fibular N (L4-S2)

100
Q

You are walking and hear the person next to you walking with a loud “clop”, you see that they have difficultly achieving a heel strike and swing their leg forward. What is causing this?

A

injury to common fibular N (L4-S2), so they have difficulty with dorsiflexion and eversion

101
Q

Injury to the cutaneous branch of the common fibular n. would present with loss of sensation where?

A

anterolateral leg and dorsum of foot

102
Q

Patient presents with pain and serious disability after a kick to the side of his knee. PE revealed a dark bruise just distal to head of fibula. What muscle(s) are likely injured?

A

tibialis anterior and extensor digitorum longus ms

103
Q

Pt fell from bike and X-ray shows tibial and fibula fx. PE reveals pt has a foot drop, but normal eversion. What nerve is most likely injured?

A

deep fibular n.

104
Q

What is the fascia covering the dorsalis pedis a. and deep fibular n. on the dorsum of the foot?

A

inferior extensor retinaculum - continuous with extensor retinaculum

105
Q

What is the fascia covering the structures of the medial malleolus?

A

flexor retinaculum

106
Q

What fascia supports the longitudinal arch of the foot which is divided into 5 bands that enclose distal tendons?

A

plantar aponeurosis

107
Q

Nerve root of Femoral N

A

L2-4

108
Q

Nerve root of Obturator N

A

L2-L4

109
Q

Nerve root of Sciatic N

A

L4-S3

110
Q

Nerve root of Tibial N

A

L4-S3

111
Q

Nerve root of Common Fibular N

A

L4-S2

112
Q

Nerve root of Lateral Femoral Cutaneous N

A

L2-3

113
Q

Nerve root of Posterior Femoral Cutaneous N

A

S1-3

114
Q

Tibial N supplies what compartment? What would a lesion to this nerve cause? How would you test this nerve?

A
  • posterior leg
  • loss of plantar flexion and weakened inversion
  • achilles tendon reflex
115
Q

What muscle tendons run under the superior flexor retinaculum?

A

Fibularis longus tendon and fibularis brevis tendon

116
Q

Sensory innervation of the Tibial N.

A

sole of foot

117
Q

Motor innervation of Tibial N

A
  • biceps Femoris, long head
  • triceps surae: gastrocnemius and soleus
  • plantaris
  • popliteus
  • flexor muscles of the foot
118
Q

What could cause injury to the tibial n?

A
  • knee trauma
  • baker cyst (proximal lesion)
  • tarsal tunnel syndrome (distal lesion)
119
Q

Presentation of tibial n injury?

A

TIP: Tibia Inverts & Plantarflexes

  • cant stand on tip toes
  • Inability to curl toes
  • loss of sensation on sole of foot
  • foot everted @ rest b/c can’t invert or plantar flex
120
Q

Presentation of inferior gluteal n injury

A
  • difficulty climbing stairs, rising from seated position

- loss of hip extension

121
Q

Presentation of femoral n injury

A

decreased leg extension & decrease patellar reflex

122
Q

Presentation of Obturator N injury

A

decreased thigh sensation (medial) and adduction

123
Q

presentation of lateral femoral cutaneous N injury (also the inferior clunial n)

A

decreased thigh sensation: anterior and lateral

124
Q

Presentation of genitofemoral n injury

A
  • decreased upper medial thigh and anterior thigh sensation beneath inguinal l (lateral femoral triangle)
  • absent cremaster reflex
125
Q

Presentation of iliohypogastric n injury

A

burning or tingling paining surgical incision site radiating to inguinal and suprapubic region

126
Q

Most Important (aka high yield for boards) specialty knee exams (5)

A
  1. anterior drawer sign
  2. posterior drawer sign
  3. abnormal passive abduction
  4. abnormal passive adduction
  5. McMurray test
127
Q

Ligament in low ankle sprain (most common)

A

Always Tear First:

Anterior TaloFibular l. - due to overinversion/supination of foot

128
Q

Ligament most common in high ankle sprain

A

Anterior inferior tibiofibular l.

129
Q

What happens if AChE is inhibited for a prolonged period of time?

A
  • ACh will stay in longer and eventually disperse, so choline will never get recycled = could result in Each depletion in membrane.
  • Hypercontraction due to constant stimulus, eventually leading to paralysis due to increase threshold of adjacent tissue to stimulation b/c of depolarization (closing of Na activation gate)
130
Q

What would happen if Ryanodine receptors could not close?

A

Continuous Ca+ release = continual contraction and this uses ATP continuously so increase in muscle cell metabolism = increased body temp = hyperthermia
-could also happen if DHP receptors could not close

131
Q

What does activation of DHP receptors cause?

A

conformational change of RyRs on SR = Ca+ release into sarcolemma

132
Q

What is in charge of sequestering the Ca+2 in the sarcolemma?

A

Ca+2/ATPase pump

133
Q

What are the two factors that determine force of muscle contraction?

A
  1. starting length of sarcomere (distance b/t myosin and acting & most efficient overlap)
  2. how rapidly the fiber is stimulated by the nerve
134
Q

3 ways to increase contractile force

A
  1. increase number of innervate muscle fibers
  2. more glycolytic fibers will generate greater force, but increased fatigue
  3. activate more motor neurons/units = recruitment
135
Q

What is an absent patellar reflex called?

A

Westphal’s sign

136
Q

Pes anserine bursitis

A
  • inflammation of anserine bursa b/t pes anserinus and MCL (overuse/trauma)
  • constant, aching pain aggregated by activity (climbing stairs), specifically flexion and IR knee
137
Q

3 disadvantages of CT

A
  1. ionizing radiation
  2. renal function 1st evaluated
  3. allergies to iodine contrast
138
Q

5 advantages of CT

A
  1. quick
  2. motion less of issue
  3. gray scale manipulation
  4. excellent resolution
  5. wide availability & cheaper than MRI
139
Q

3 Advantages of MRI

A
  1. no ionizing radiation
  2. better soft tissue contrast than CT
  3. versatile
140
Q

Contrast agents used in MRI

A

IV gadolinium and Oral agents (juice, H2O)

141
Q

Disadvantages of MRI

A
  1. longer & more expensive
  2. can’t be manipulated after like CT
  3. bad if claustrophobic
  4. no metal in body
  5. Gadolinium can’t be used in pregnant women
  6. Pple with poor renal function have increased risk of NSF (nephrogenic systemic fibrosis)
  7. loud

MSK 2 (6 decks)

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