Lower Extremity

Front 1

What are the superficial veins of the lower extremity that originate on the dorsal venous arch of the foot?

Back 1

1. Great saphenous vein
2. Small saphenous vein

Front 2

Where is the great saphenous vein located?

Back 2

ascends anterior to the medial malleolus, up the medial leg

Front 3

Where is the small saphenous vein located?

Back 3

ascends posterior to the lateral malleolus, and up the middle of the posterior leg (deep to crural fascia in upper leg)

Front 4

Where does the small saphenous vein empty?

Back 4

into the popliteal vein

Front 5

Where does the great saphenous go after going up the medial leg?

Back 5

to the posteromedial knee > anteromedial thigh > through saphenous hiatus in fascia lata > empties into FEMORAL vein

Front 6

What does the great saphenous vein drain?

Back 6

dorsum of foot, anterior leg, and anterior, medial and lateral thigh

Front 7

The great saphenous vein and the small saphenous vein are connected to the deep veins of the leg through which structures?

Back 7

perforating veins

Front 8

Perforating veins contain valves to do what?

Back 8

prevent back flow from deep veins into superficial veins

Front 9

Action of perforating veins?

Back 9

to get blood from the superficial veins to the deep veins

Front 10

Failure of valves in perforating veins results in what?

Back 10

varicose veins -- b/c blood from deep veins back flow into the superficial veins.

Front 11

Superficial lymph vessels accompany which structures?

Back 11

superficial veins

Front 12

Where do superficial lymph vessels terminate?

Back 12

superficial inguinal lymph nodes

Front 13

Where does lymph from the superficial inguinal nodes drain?

Back 13

into the external iliac lymph nodes, but SOME drain into the deep inguinal lymph nodes

Front 14

Superficial inguinal nodes drain lymph from which structures?

Back 14

1. lower abdominal wall
2. external genitalia
3. perineum
4. buttocks
5. lower limb

Front 15

Deep lymph vessels accompany which structures, and drain where?

Back 15

accompany deep veins of leg and drain into the deep inguinal lymph nodes

Front 16

How many deep inguinal lymph nodes are there?

Back 16

3

Front 17

Where are the deep inguinal lymph nodes located?

Back 17

In the femoral canal, MEDIAL to the femoral vein.

Front 18

The saphenous nerve is a brach from which nerve?

Back 18

Femoral nerve

Front 19

Where does the saphenous nerve provide cutaneous innervation?

Back 19

Anterior and medial side of leg, & medial side of foot

Front 20

The saphenous nerve runs with which structure?

Back 20

great saphenous vein

Front 21

Which nerve is formed from BOTH the tibial and common fibular nerves?

Back 21

Sural nerve

Front 22

The sural nerve accompanies which structure?

Back 22

Small saphenous vein

Front 23

Sural nerve provides cutaneous innervation to which parts of the body?

Back 23

Posterior and lateral aspects of the leg and lateral foot

Front 24

The superficial fibular nerve is a branch of which nerve?

Back 24

Common fibular nerve

Front 25

The superficial fibular nerve provides cutaneous innervation to which parts of the body?

Back 25

inferior 1/3 of the anterior leg and dorsum of the foot

Front 26

What is the "fascia lata?"

Back 26

The deep fascia of the THIGH

Front 27

What is the "crural fascia?"

Back 27

The deep fascia of the LEG

Front 28

3 specializations of the fascia lata in the thigh:

Back 28

1. IT tract
2. Lateral inter-muscular septum
3. Medial inter-muscular septum

Front 29

Where does the IT band connect?

Back 29

Illiac crest to the lateral condyle of the tibia

Front 30

What separates the quads from the hamstrings?

Back 30

Lateral inter-muscular septum

Front 31

What separates the quads from the adductor muscles

Back 31

Medial inter-muscular septum

Front 32

3 specializations of the crural fascia in the leg:

Back 32

1. Posterior inter-muscular septum
2. Transverse inter-muscular septum
3. Anterior inter-muscular septum

Front 33

The posterior inter-muscular septum separates what?

Back 33

The posterior (flexor) muscles from the lateral (fibular) muscles

*Boundary btwn posterior and lateral compartments

Front 34

The transverse inter-muscular septum separates what?

Back 34

DEEP posterior muscles from the SUPERFICIAL posterior muscles

Front 35

The anterior inter-muscular septum separates what?

Back 35

The anterior (extensor) muscles from the lateral (fibular) muscles

*Boundary btwn anterior and lateral compartments

Front 36

What are the borders of the femoral triangle?

Back 36

1. inguinal ligament (superiorly)
2. sartorius (lateral)
3.adductor longus (medial)

Front 37

What are the contents of the femoral triangle from lateral to medial?

Back 37

NAVL
femoral nerve, femoral artery, femoral vein, and DEEP inguinal lymph node

Front 38

Femoral triangle contents pass deep to the inguinal ligament, and are enclosed in what?

Back 38

Femoral sheath, EXCEPT femoral nerve is not.

Front 39

The femoral sheath is part of what?

Back 39

The transversalis fascia of the abdominal wall

Front 40

What's in the LATERAL compartment of femoral sheath?

Back 40

femoral artery

Front 41

Whats in the MIDDLE compartment of the femoral sheath?

Back 41

femoral vein

Front 42

What's in the MEDIAL compartment of the femoral sheath? AKA "femoral canal"

Back 42

Fat & deep inguinal node (node of Cloquet)

Front 43

What is known as the opening at the superior end of the femoral canal?

Back 43

femoral ring

Front 44

What is a femoral hernia?

Back 44

When part of the small intestine protrudes through the FEMORAL RING, into the femoral canal

Front 45

Femoral hernia VS inguinal hernia?

Back 45

The swelling of an inguinal hernia is superior to the inguinal ligament

Front 46

Women are more likely than men to have what type of hernia?

Back 46

femoral hernia

Front 47

What is an important site for catheterization?

Back 47

Femoral triangle

Front 48

Catheterization of the femoral artery is used for what?

Back 48

1. coronary angiography
2. percutaneous coronary transluminal angioplasty
3. stent placement

Front 49

Catheterization of the femoral vein for introduction of what??

Back 49

Swan-Ganz Katheter

Front 50

What is a Swan-Ganz catheter?

Back 50

catheter into the right side of the heart and arteries leading to the lungs, to monitor hearts function and blood flow.

Front 51

Swan-Ganz catheter can measure what?

Back 51

1. central venous pressure
2. pulmonary artery wedge pressure
3. cardiac output

Front 52

Risk factors of catheterization?

Back 52

1. damage to femoral artery
2. damage to femoral vein
3. damage to femoral nerve
4. AV fistula --abnormal connection btwn artery and vein.

Front 53

Femoral vessels are less of a risk for catheterization compared to what?

Back 53

subclavian approaches

Front 54

Risk factors of subclavian catheterization?

Back 54

1. Pneumothorax
2. thromboembolism of internal carotid artery and subsequent stroke.

Front 55

What makes up the adductor canal?

Back 55

Lateral: vastus medialis
Medial: sartorius
Posterior: adductor longus
Roof: sartorial

Front 56

Adductor canal serves as a passage way for which structures?

Back 56

femoral vessels and saphenous nerve in the middle third of the thigh.

Front 57

Where does the adductor canal end?

Back 57

At the adductor hiatus, which is an opening in the adductor magnus muscle

Front 58

Where do the femoral vessels travel?

Back 58

from the anterior thigh to the popliteal region

Front 59

Which artery supplies most of the thigh?

Back 59

femoral artery

Front 60

MAJOR branch of the femoral artery?

Back 60

deep femoral artery (profunda femoris)

Front 61

The profunda femoris supplies which structures?

Back 61

hip joint, proximal and posterior thigh including neck of femur

Front 62

Major blood supply to the hamstrings?

Back 62

Deep femoral artery

Front 63

Branches of the deep femoral artery?

Back 63

1. Medial circumflex femoral artery
*supplies hip joint
2. Lateral circumflex femoral artery
*supplies lateral hip, thigh and knee

Front 64

What area on the body does the obturator artery supply?

Back 64

Medial thigh and hip--including limited supply to head of femur!

Front 65

Obturator nerve supplies which muscles?
(L2, 3, 4)

Back 65

adductor muscles

Front 66

Injury to obturator nerve results in?

Back 66

Inability to adduct and flex the thigh.

Front 67

The obturator nerve lies between which two structures?

Back 67

Adductor longus and brevis

Front 68

The femoral nerve supplies which muscles?
(L2, 3, 4)

Back 68

Quadriceps

Front 69

Injury to femoral nerve results in?

Back 69

Inability to extend the leg

Front 70

The femoral nerve lies superficial to which muscle?

Back 70

psoas major

Front 71

Other muscles the femoral nerve innervates?

Back 71

1. sartorius
2. rectus femoris
3. illiopsoas
4. pectineus

*Injury results in inability to FLEX the thigh.

Front 72

Branch of sciatic nerve?

Back 72

L4-S3

Front 73

2 parts of sciatic nerve?

Back 73

Tibial nerve and common fibular nerve

Front 74

Anterior branches of L4-S3?

Back 74

Tibial nerve

Front 75

Posterior branches of L4-S2?

Back 75

Common fibular nerve

Front 76

Where does the sciatic nerve exit?

Back 76

through the greater sciatic foramen, passing under the piriformis muscle

Front 77

Where does the sciatic nerve end up?

Back 77

posterior thigh

Front 78

Safest place to give IM injections?

Back 78

upper outer quadrant of buttocks (to avoid path of sciatic nerve)

Front 79

Motor innervation of sciatic nerve??

Back 79

Hamstrings, and all of muscles of leg and foot

Front 80

Roots of superior gluteal nerve

Back 80

(L4-S1)

Front 81

Inferior gluteal nerve roots?

Back 81

(L5-S2)

Front 82

Location of superior gluteal nerve and its innervation?

Back 82

superior to the piriformis
Innervates gluteus medius and minimus and tensor fascia lata

Front 83

Location of inferior gluteal nerve and its innervation?

Back 83

inferior to the piriformis
innervates gluteus maximus

Front 84

What passes through the greater sciatic foramen?

Back 84

1. superior gluteal nerve
2. inferior gluteal nerve
3. pudenal nerve

Front 85

What weird course does the pudenal nerve take in the body?

Back 85

It passes through the greater sciatic foramen, but then loops back through the lesser sciatic foramen to enter the perineum via pudenal canal

Front 86

Pelvic splanchnic nerve roots

Back 86

S2,3, 4

Front 87

Course and innervation of pelvic splanchnic nerve roots

Back 87

to the inferior hypogastric plexus, and are involved in autonomic bladder regulation, bowel function and sexual response in males/females

Front 88

Where do semitendinosus and semimembranosus insert?

Back 88

Tibia

Front 89

Where does biceps femoris attach?

Back 89

Fibula

Front 90

What is different about the short head of biceps femoris?

Back 90

It's not really a hamstring, and it's innervated by the common fibular nerve

Front 91

Which "part" of a muscle is a hamstring muscle and what innervates it?

Back 91

adductor magnus, innervated by tibial nerve

Front 92

A positive trendelenburg sign indicates injury to which nerve?

Back 92

superior gluteal nerve

Front 93

Superior gluteal nerve injury affects which hip?

Back 93

The pelvis drops on the OPPOSITE side of the nerve injury.

Front 94

When left gluteal muscles are weak....

Back 94

the right pelvis drops when the right foot is off the ground

Front 95

Action of gluteus maximus:

Back 95

extends the thigh

Front 96

Action of hamstring:

Back 96

extend the thigh and flex the leg at the knee

Front 97

Result of an injury to the sciatic nerve?

Back 97

weak/absent extension of the thigh, and/or flexion of the leg

Front 98

Sciatic nerve injury will cause loss of innervation to what other areas of the body?

Back 98

leg and foot, causing foot drop

Front 99

Action of tensor of fascia lata:

Back 99

Flexes the thigh and fixes the femur on the tibia with standing

Front 100

Nerve innervation of tensor of fascia lata?

Back 100

superior gluteal nerve

Front 101

Action of iliopsoas muscle:

Back 101

Chief hip flexor

Front 102

Nerve innervation of iliopsoas muscle?

Back 102

L1 and L2 and femoral nerve (L2, 3)

Front 103

Action of piriformis muscle:

Back 103

lateral hip rotator, innervated by S1, S2

Front 104

Where do hip lateral rotators and abductors insert?

Back 104

Greater trochanter of femur

Front 105

What arteries supply blood to the hip joint?

Back 105

Medial and lateral circumflex arteries

Front 106

Medial and lateral circumflex arteries are branches of:

Back 106

profunda femoris artery

Front 107

Articulations of the knee:

Back 107

2 tibiofemoral, and 1 patellofemoral

Front 108

5 extracapsular ligaments:

Back 108

1. patellar ligament
2. LCL
3. MCL
4. Oblique popliteal ligament
5.Arcuate popliteal ligament

Front 109

1) Patellar ligament origin and insertion:

Back 109

origin: distal quads
insertion: tibial tuberosity

Front 110

2) LCL origin and insertion:

Back 110

origin: lateral epicondyle of femur
insertion: lateral surface of head of fibula

*"cordlike" and SEPARATED from lateral meniscus

Front 111

3) MCL origin and insertion:

Back 111

origin: medial epicondyle of femur
insertion: medial surface of tibia

*"flat band" and CONNECTED to medial meniscus

Front 112

4) Oblique popliteal ligament:

Back 112

expension of semiMEMBRANosus tendon

Front 113

5) Arcuate popliteal ligament:

Back 113

strengthens posterior fibrous capsule of joint

Front 114

ACL origin and insertion:

Back 114

origin: anterior intercondylar area of tibia
insertion: lateral condyle of femur

Front 115

PCL origin and insertion:

Back 115

origin: posterior intercondylar area of tibia
insertion: medial condyle of femur

Front 116

Function of ACL

Back 116

prevents posterior displacement of femur on tibia

or... anterior displacement of tibia on femur

Front 117

Function of PCL

Back 117

prevents posterior displacement of tibia on femur

or... anterior displacement of femur on tibia

Front 118

Shapes of menisci

Back 118

Medial is "C" shaped and attached to MCL
Lateral is "O" shaped at more freely movable

Front 119

Vascularity of menisci:

Back 119

Central 2/3 = avascular (white zone)
Outer 1/3 = vascular (red zone)

Front 120

The "terrible triad" includes:

Back 120

1.ACL
2.MCL
3.Medial meniscus

*blunt force to lateral knee, knee flexed and leg is twisting while foot is planted.

Front 121

Most common sports for the following injuries:
ACL, PCL, medial meniscus

Back 121

ACL: skiing
PCL: basketball
Medial meniscus: football and volleyball

Front 122

Artery that ruptures with ACL tear that causes swelling

Back 122

tibial intracondylar artery

Front 123

What is the preferred allograft?

Back 123

Achille's Tendon

Front 124

What is the preferred autograft?

Back 124

middle third of patellar tendon

Front 125

Other tendon option for autograft?

Back 125

quadrupled semitindinsus-gracilis (fewer risks for patellar fx, and post-op ant knee pain)

Front 126

3 superficial bursa:

Back 126

a prepatellar bursa, and 2 infrapatellar (one subcutaneous, one deep)

Front 127

Largest bursa where infections can spread

Back 127

suprapatellar bursa

Front 128

5th quad muscle

Back 128

articularis genu (found deep to vastus intermedius)

Front 129

Function of articularis genu:

Back 129

pulls suprapatellar bursa superiorly during extension to prevent pinching of bursa between patella and femur

Front 130

nerve innervation of hamstrings:

Back 130

tibial division of sciatic nerve

Front 131

The insertion of 3 tendons of muscles on the medial surface of the tibia:

Back 131

pes anserinus (goose foot)

Front 132

3 muscles that attach at medial surface of tibia and look like goose foot are:

Back 132

1. sartorius
2. gracilis
3. semitendinosus

Front 133

Action of plantar is muscle:

Back 133

weakly assists gastrocnemius in plantar flexion

Front 134

"organ of proprioception" for gastroc

Back 134

plantaris muscle

Front 135

Plantaris tendon is a source of tendon graft for:

Back 135

hand surgery

Front 136

Action of popliteus

Back 136

rotates femur 5 degrees laterally on the tibia to unlock knee from extended position

Front 137

Boundaries of popliteal fossa:

Back 137

Superior: hamstrings
Medial: semitendinosus and semimembranosus
Lateral: biceps femoris
Inferior: 2 heads of gastrocnnemius

Front 138

Structures inside the popliteal fossa:

Back 138

1. Small saphenous vein
2. popliteal arteries
3. popliteal veins
4. Tibial and common fibular nerve

Front 139

Deepest structure in popliteal fossa?

Back 139

popliteal artery (continuation of femoral artery)

Front 140

The popliteal artery bifurcates into which 2 arteries?

Back 140

Anterior and posterior tibial arteries

Front 141

Is the popliteal VEIN superficial or deep to the popliteal artery?

Back 141

Vein is superficial

Front 142

Most superficial structure in popliteal fossa?

Back 142

tibial nerve

Front 143

Area of bifurcation of sciatic nerve?

Back 143

at the superior angle of the popliteal fossa, breaks into the common fibular and tibial nerve

Front 144

Tibial nerve innervation:

Back 144

posterior aspect of leg and plantar aspect of foot

Front 145

Common fibular nerve innervation:

Back 145

winds around the head/neck of fibula, in a superficial position (susceptible to injury!!)

Front 146

Most injured nerve in lower extremity:

Back 146

common fibular nerve

Front 147

Impingement/injury to common fibular nerve results in:

Back 147

foot drop and a "steppage gait"

Front 148

Division of the common fibular nerve:

Back 148

superficial fibular branch (lateral)
deep fibular branch (anterior)

Front 149

4 muscles of anterior compartment of leg:

Back 149

1. tibialis anterior
2. extensor hallucis longus
3. extensor digitorum longus
4. fibularis tertias

Front 150

Artery that supplies the anterior compartment of the leg?

Back 150

anterior tibial artery

Front 151

Compression of deep fibular nerve results in:

Back 151

loss of sensation between second and great toes

Front 152

Paralysis of muscles in anterior compartment results in:

Back 152

foot drop

Front 153

2 muscles of lateral compartment:

Back 153

1. fibularis longus
2. fibularis brevis (deep to longus)

Front 154

Which artery supplies the lateral compartment?

Back 154

Fibular artery (a branch of the posterior tibial artery)

Front 155

Nerve innervation of lateral compartment

Back 155

superficial fibular nerve

Front 156

Action of lateral compartment muscles:

Back 156

evert the foot, assist w/ plantar flexion

Front 157

How are the superficial and deep posterior compartments separated?

Back 157

Transverse intermuscular septum

Front 158

3 muscles of SUPERFICIAL posterior compartment:

Back 158

1. Gastrocnemius
2. Plantaris
3. Soleus

Front 159

Blood supply to gastroc and soleus??

Back 159

posterior tibial artery

Front 160

4 muscles of the DEEP posterior compartment:

Back 160

1. popliteus
2. flexor hallucis longus
3. flexor digitorum longus
4. tibialis posterior

Front 161

Which artery supplies the flexor hallucis longus, flexor digitorum longus, and tibilais posterior?

Back 161

posterior tibial artery

Front 162

Arrangement of deep posterior compartment muscles, from lateral to medial:

Back 162

flexor hallucis longus, tibialis posterior, flexor digitorum longus

Front 163

Order of tendons at medial malleolus from anterior to posterior

Back 163

TOM DICK AND NERVOUS HAIR

Front 164

Action of superficial posterior compartment muscles

Back 164

plantar flex the foot

Front 165

Action of tibias posterior

Back 165

Foot inversion

Front 166

Actioin of flexor hallucis longus

Back 166

flexes distal phalanx of great toe
(assist w/ plantar flexion)

Front 167

Action of flexor digitorum longus

Back 167

Flexes distal phalanges of lateral 4 toes
(assist w/ plantar flexion)