Lower Limb Oral Questions

Front 1

How can you identify the hip bone right or left?

Back 1

a) the iliac crest: is directed upwards while the ischium is directed downwards

b) the pubic bone: is anterior

c) the acetabulum: is directed mainly laterally

d) the greater sciatic notch: is directed posteriorly

Front 2

what are the structures attached to the acetabular margin?

Back 2

a) labrum acetabulare

b) transverse ligament of acetabulum: bridges over the acetabular notch

Front 3

name the structures attached to the anterior superior and anterior inferior iliac spine

Back 3

Anterior superior iliac spine:
1. sartorius
2. inguinal ligament

Anterior inferior iliac spine:
1. straight head of rectus femoris
2. iliofemoral ligament

Front 4

what are the levels of the iliac crest in relation to the vertebral column?

Back 4

a) tubercle of iliac crest: 5th LV
b) highest point of iliac crest: 4th LV
c) posterior superior iliac spine: 2nd SV

Front 5

name the muscles attached to the gluteal surface. give their origin from the hip bone and nerve supply

Back 5

a) Gluteus maximus: behind the posterior gluteal line (nerve: inferior gluteal)

b) Gluteus medius: between the posterior and anterior gluteal lines (nerve: superior gluteal)

c) Gluteus minimus: between the anterior and inferior gluteal lines (nerve: superior gluteal)

d) Reflected head of rectus femoris: from a groove just above the acetabulum

Front 6

Name the structures attached to the pubic tubercle

Back 6

a) inguinal ligament

b) cremaster muscle

Front 7

Give the muscles and ligaments attached to the ischial tuberosity. define their sites of attachment.

Back 7

a) semimembranosus: from the upper lateral area

b) common origin of biceps and semitendinosus: from its lower medial area

c) adductor magnus; from the lateral area of its lower part (the medial area is subcutaneous)

d) quadratus femoris: from the latereal margin of the tuberosity

e) sacrotuberous ligament: from the medial margin of the tuberosity

Front 8

enumerate the structures passing throught the greater sciatic foramen

Back 8

- piriformis muscle

-above the piriformis: superior gluteal nerve and vessels

-below the piriformis:
1. sciatic nerve
2. inferior gluteal nerve and vessels
3. posterior cutaneous nerve of thigh
4. nerve to quadratus femoris
5. structures that leave the greater sciatic foramen and enter the lesser sciatic foramen: nerve to obturator internus, pudendal nerve and internal pudendal vessels

Front 9

Name the structures passing through the lesser sciatic foramen

Back 9

a) tendon of obturator internus
b) nerve to the obturator internus
c) pudendal nerve
d) internal pudendal nerves

Front 10

what are the main features that help in sexing the hip bone?

Back 10

) the greater sciatic notch: deep and narrow in males but shallow and wide in females

b) the side of the pubic arch: rough and much everted in males (for the thick crus of penis) but smooth and slightly everted in females

c) the pre-auricular sulcus: (infront of the auricular surface) is not present in males but is deep in females

d) the obturator foramen: oval in males but triangular in females

e) the length of the superior pubic ramus as far as the symphysis pubis: is longer than the diameter of the acetabulum in the female but equal to it in the male

Front 11

Give the age at which the hip bone becomes a complete bone

Back 11

a) the ramus of the ischium fuses with the inferior ramus of the pubis at 8 years

b) the 3 parts of the hip bone unite in the acetabulum by bone at about 15 years

Front 12

what are the structures attached to the intertrochanteric line

Back 12

a) iliofemoral ligament
b) capsule of the hip joint
d) the highest fibres of bastus lateralis and medialis muscles

Front 13

Name the muscles attached to the greater trochanter. give their nerve supply and site of attachment

Back 13

1) piriformis: into its top (nerve: branches from sacral plexus)

2) Gluteus minimus: into its anterior surface (nerve: superior gluteal)

3) gluteus medius: into an oblique ridge on its lateral surface (nerve: superior gluteal)

4) Quadratus femoris: into the quadrate tubercle (nerve: branches from the sacral plexus)

5) Obturator internus: into its medial surface (nerve: nerve to the obturator internus from the sacral plexus)

6) Obturator externus: into the trochanteric fossa (nerve: obturator nerve from the lumbar plexus)

Front 14

Describe the main features of the posterior aspect of the shaft of femur

Back 14

a) Middle 1/3: formed by the linea aspera

b) Upper 1/3: there are the spiral line and gluteal tuberosity

c) Lower 1/3: there are the 2 supracondylar ridges which bound the popliteal surface

Front 15

Name the muscles attached to the linea aspera as arranged from lateral to medial, and give their nerve supply

Back 15

1) Vastus lateralis (femoral nerve)
2) short head of biceps (sciatic nerve)
3) adductor magnus (obturator and sciatic nerves)
4) adductor brevis (obturator nerve)
5) adductor longus (obturator nerve)
6) vastus medialis (femoral nerve)

Front 16

Name the muscles attached to the gluteal tuberosity and give their nerve supply

Back 16

a) Deep part of the gluteus maximus : inferior gluteal nerve
b) pubic cpart of adductor magnus: obturator nerve
c) vastas lateralis: femoral nerve

Front 17

Name the structures attached to the epicondyles of the femur

Back 17

1) medial epicondyle : tibial collateral ligament

2) lateral epicondyle: fibular collateral ligament

Front 18

define the groove for the origin of popliteus and give the nerve supply to that muscle

Back 18

the groove lies just below the lateral epicondyle. the muscle is supplied by the tibial nerve

Front 19

what are the muscles attached to the popliteal surface of the femur?

Back 19

a) plantaris: just above the lateral condyle
b) medial head of gastrocnemius: just above the medial condyle

Front 20

describe the line of attachment of the capsule of the hip joint on the neck of the femur

Back 20

a) anteriorly: attached to the intertrochnateric line just deep to the iliofemoral ligament

b) posteriorly: about the middle of the neck of the femur. the tendon of the obturator externus is related to the lateral part of the back of the neck just lateral to the attachment of the capsule

Front 21

Name the ligaments of the knee joint

Back 21

a) tibial collateral ligament (medial)
b) fibular collateral (lateral)
c) oblique popliteal ligament (posterior)
d) anterior and posterior cruciate ligaments (inside)
e) ligamentum patellae (anterior)

Front 22

name the main structures present inside the knee joint

Back 22

a) two menisci (lateral and medial)
b) two cruciate ligaments (anterior and posterior)
c) tendon of popliteus
d) transverse ligament of the knee
e) infrapatellar fold of fat
f) alar folds

Front 23

mention the differences between the medial and lateral leminsici

Back 23

1) the medial meniscus is larger and its horns are more widely separated from each other than the lateral leminscus which is more circular

2) the medial meniscus is attached to the capsule of the knee and to the tibial collateral ligament, while the lateral meniscus is separated from the capsule and fibular collateral ligament by the tendon of the popliteus

Front 24

describe the attachments and function of the cruciate ligaments

Back 24

-anterior cruciate: from the anterior part of the intercondylar area of the tibia to the posterior part of the inner surface of the lateral condyle of femur

-posterior cruciate: from the posterior part of the intercondylar area of tibia to the anterior part of the inner surface of the medial condyle of femur.

- the naterior ligament is fully stretched in extension while the posterior ligament is fully stretched in flexion

Front 25

what is meant by locking and unlocking of the knee joint

Back 25

-at the end of full extension of the knee the femur rotates medially (or the tibia rotates laterally). this rotation is called locking of the knee.
-in the start of flexion the reverse movement takes place (by the action of the popliteus) this is unlocking of the knee

Front 26

name the main bursae related to the knee joint

Back 26

1) suprapatellar: above the patella between the quadriceps and the femur (communicates with the joint cavity)

2) infrapatellar: below the patella (one superficial and one deep)

3) prepatellar : in front of the patella

4) semimembranosus bursa; deep to the insertion of the semimembranosus muscle

Front 27

enumerate the surface landmarks of the femur

Back 27

a) the 2 condyles
b) greater trochanter: a hands breadth below the iliac crest
c) the adductor tubercle: can be felt by taking the tendon of the adductor magnus as a guide

Front 28

how can you identify the patella right or left

Back 28

put the patella with its posterior surface on the table and its apex directed away from you. if its anterior surface looks to the right it is a right patella, and if it looks to the left it is a left patella. this is because the lateral facet of the patella is larger than the medial facet.

Front 29

how can you identify the tibia right or left?

Back 29

1) the anterior border (shin of the tibia) begins above at the tuberosity of the tibia

2) on the upper part of the posterior surface there is the soleal line

3) the medial aspect is marked below the medial malleolus

4) the lateral aspect: is marked above by the facet for the head of the fibula on the under surface of the lateral condyle, while bleow it is marked by the notch for the fibula

Front 30

name the structures attached to the intercondylar area of the upper end of the tibia, as arranged from before backwards

Back 30

1. anterior horn of medial meniscus (most anterior)
2. anterior cruciate ligament
3. anterior horn of lateral mensicus
4. posterior horn of lateral mensicus
5. posterior horn of medial meniscus
6. posterior cruciate ligament (most posterior)

Front 31

what are the muscles attached to the upper part of the medial surface of the tibia? give their nerve supply

Back 31

1) S sartorius : femoral nerve
2) G gracilis: obturator nerve
3) S semitendinosus: sciatic nerve

Front 32

name the muscles attached to the upper part of the posterior surface of the tibia, and give the type of attachment

Back 32

1) popliteus: into the area above the soleal line (insertion)
2) soleus: from the soleal line (origin)

Front 33

what are the structures attached to the lower end of the tibia

Back 33

they are all ligaments
a) deltoid ligament: from the tip of the medial malleolus to the calceneus, talus and navicular as well as to the spring ligament

b) anterior and posterior tibiofibular ligaments

Front 34

name the structures related to the medial malleolus

Back 34

a) anteriorly: crossed by
1. great saphenous vein
2. saphenous nerve

b) posteriorly: deeply grooved by the tendon of tibialis posterior

c) tip: gives attachment to the deltoid ligament

Front 35

name the articulations related to the tibia

Back 35

1) knee joint
2) superior tibio-fibular joint
3) inferior tibiofibular joint
4) ankle joint

Front 36

what are the parts of the tibia felt under the skin (Subcutaneous landmarks)

Back 36

1) the 2 condyles
2) tibial tuberosity
3) anterior border
4) medial malleolus
5) medial surface of the shaft

Front 37

how can you know the fibula right or left?

Back 37

a) the head: directed upwards
b) the articular smooth surface of the lower end : is directed medially
c) the malleolar fossa: lies posterior to the articular surface of the lower end. so the fibula is better identified from the lower end.

Front 38

name the structures attached to the head of the fibula

Back 38

a) fibular collateral ligament of the knee joint

b) biceps femoris: (insertion)

Front 39

what are the important relations of the neck of the fibula

Back 39

a) common peroneal nerve: lies on the lateral surface of the neck

b) anterior tibial vessels: pass forwards medial to the neck to enter the anterior compartment of the leg

Front 40

name the joints related to the fibula, and giv their types

Back 40

a) superior tibiofibular joint (synovial)
b) inferior tibiofibular joint (fibrous)
c) ankle joint (synovial)

Front 41

what are the grooves related ot the tarsal bones

Back 41

1) on the cuboid: from the peroneus longus muscle
2) on the back of the talus: for the flexor hallucis longus
3) on the undersurface of the sustenaculum tali of the calcaneus: for the flexor hallucis longus

Front 42

what are the bones forming the longitudinal arches of the foot?

Back 42

a) medial longitudinal arch:
calcaneus talus, navicular, 3 cuneiform bones and medial 3 metatarsal bones

b) lateral longitudinal arch:
calcaneus, cuboid and lateral 2 metatarsal bones

Front 43

name the main muscles supporting the arches of the foot and give their nerve supply

Back 43

a) muscles passing from side to side:
1. tibialis posterior (tibial nerve)
2. peroneus longus (superficial petrosal nerve)

b) muscles passing from behind forwards:
1. flexor digitorum brevis (medial plantar nerve)
2. flexor hallucis longus (tibial nerve)
3. flexor digitorum longus: tibial nerve

Front 44

name the main ligaments supporting the arches of the foot

Back 44

1) spring ligament (plnatar calcaneo-navicular ligament): from the navicular bone to the sustenaculum tali of the calcaneus

2) long plantar ligament: from the calcaneus to the bases of the 2nd, 3rd, 4th metatarsal bones

4) bifurcate ligament: from the calcaneus to both the cuboid and navicular bones (on the dorsum)

5) plantar aponeurosis: thickened deep fascia that extends from the calcaneus to the sides of the metatarsophalangeal joints

Front 45

mention the relations of the spring ligament

Back 45

1) its upper surface: supports the head of the talus

2) its lower surface: is supported by the tendon of the tibialis posterior

Front 46

what are the functions of the arches of the foot?

Back 46

1) they support the body wieght

2) they help to propel the body in walking and running

3) they protect the vessels and nerves that lie in the sole of the foot

Front 47

enumerate the muscles forming the floor of the femoral triangle (lateral to medial)

Back 47

1. iliacus
2. psoas major
3. pectineus
4. adductor longus

Front 48

what are the contents of the femoral sheath?

Back 48

1. lateral compartment: femoral artery and femoral branch of the genito-femoral nerve
2. intermediate compartment: femoral vein
3. medial compartment : femoral canal

Front 49

enumerate the structures in the roof of the femoral triangle

Back 49

* nerves : ilioinguinal nerve and femoral branch of genitofemoral
* vessels:
1. superficial circumflex iliac artery and vein
2. superficial epigastric artery and vein
3. superficial external pudendal artery and vein
4. great saphenous vein

*superficial inguinal lymph nodes

Front 50

what are the attachments of the iliotibial tract?

Back 50

it extends from the tubercle of the iliac crest (above) to the anterolateral surface of the lateral condyle of the tibia

Front 51

define the position of the saphenous opening

Back 51

it lies 3 cm below and lateral to the pubic tubercle

Front 52

enumerate the structures passing through the cribriform fascia

Back 52

1. great saphenous vein
2. superficial inguinal arteries (not veins)
3. lymphatics between the superficial and deep inguinal nodes

Front 53

how can you identify the posterior superior iliac spine ? give its level

Back 53

- its position is demarcated on the back of the buttock as a skin dimple about 5 cm lateral to the median plane
-it lies opposite the 2nd sacral vertebra

Front 54

name the contents of the obturator canal and describe their termination

Back 54

1) obturator nerve: ends by giving off anterior and posterior divisions that pass in front of and behind the adductor brevis respectively

2) obturator artery: gives off anterior and posterior divisions that end by anastomosing togheter on the outer surface of the obturator membrane deep to the obturator externus

Front 55

name the vessels that enter the hip joint deep to the transverse acetabular ligament and give their importance

Back 55

these are the acetabular branches of the medial circumflex and obturator arteries. they reach the head of the femur along the round ligament of the head of femur.

Front 56

how can you palpate the adductor tubercle?

Back 56

the tendon of the adductor magnus is taken as a guide to the adductor tubercle

Front 57

name the tendon related to the back of the neck of the femur and give its action

Back 57

it is the tendon of the obturator externus. it is a lateral rotator of the hip joint.

Front 58

describe the epiphysial arteries which supply the head of the femur

Back 58

1) lateral epiphyseal arteries: arise from the medial and lateral circumflex femoral arteries and pass upwards along the neck of the femur (may be interrupted in fractured neck)

2) Medial epiphyseal arteries: arise from the obturator and medial circumflex arteries and run along the round ligament of the head of the femur

Front 59

name the grooves on the tibia that are related to muscles

Back 59

1) groove on the back of the medial condyle for semimembranosus
2) groove on the back of the medial malleolus for tibialis posterior

Front 60

how can you identify the head of the fibula

Back 60

the head of the fibula lies in the same horizontal line passing through the tuberosity of the tibia. the tendon of the bicsp femoris is a guide to it.

Front 61

name the vessels passing infront of hte medial and lateral malleolus

Back 61

1) in front of the medial malleolus: great saphenous vein
2) in front of the lateral malleolus: perforating branch of the peroneal artery (it may replace the dorsalis pedis)

Front 62

with which bones does the talus articulate? mention the joints and the movements at these articulations

Back 62

1) with the tibia and fibula: to form the ankle joint (dorsiflexion and plantar flexion)
2) with calcaneus; to form the subtalar joint (inversion and eversion)
3) with the navicular bone: to form the talonavicular joint (adduction, eversion and inversion)

Front 63

give the insertion of the quadriceps femoris

Back 63

into the following:
1. patella
2. tuberosity of the tibia
3. fibrous capsule of the knee joint
4. synovial membrane of the knee joint

Front 64

give the action and insertion of the gluteus maximus

Back 64

-action: main extensor of the hip joint

-insertion:
1) superficial 3/4: into the posterior border of the iliotibial tract
2) deep 1/4: into the gluteal tuberosity

Front 65

where can you identify the great saphenous vein?

Back 65

1) in front of the medial malleolus
2) along the medial border of tibia
3) behind the medial condyles of tibia and femur
4) on the medial side of the thigh (up to the saphenous opening)

Front 66

enumerate the veins with which the great saphenous vein communicates

Back 66

1) the small saphenous (close to the popliteal fossa)
2) the deep veins of the leg (through communicating veins)
3) the lateral thoracic vein (of the axillary vein) to form the thoracoepigastric vein (indirectly through the superficial epigastric vein)
4) it ends in the femoral vein

Front 67

describe the drainage of venous blood of the lower limb

Back 67

1) most blood returns by way of the deep veins eg tibial, popliteal and femoral

2) small amount returns by way of the superficial veins (great saphenous and small saphenous)

3) the valves in the communicating veins direct the blood from the superficial to the deep veins (this is reversed in the case of damage to the valves leading to varicose veins)

Front 68

Name the groups of lymph nodes in the lower limb and give their sites

Back 68

1) inguinal lymph nodes (superficial and deep) : lie just below the inguinal ligament

2) popliteal nodes: small in size and number and lie deep to the fascial roof of the popliteal fossa

Front 69

the upper lateral quadrant of the buttock is commonly used for intramuscular injection, explain why?

Back 69

because it is relatively avascular and free of major nerves. the injection passes directly through the gluteus medius and minimus muscles

Front 70

name the muscles supplied by the superior gluteal nerve and give the effect of paralysis of this nerve

Back 70

-the muscles are: gluteus minimus and tensor fascia latae
- paralysis of the nerve leads to failure of the aduction of the hip joint resulting in waddling gait

Front 71

name the lateral rotators of the hip and give their nerve supply

Back 71

1) piriformis: by branches from the sacral plexus
2) obturator internus : by the nerve to obturator internus (from the sacral plexus)
3) obturator externus: by the obturator nerve ( from the lumbar plexus)
4) 2 gemelli: the superior gemellus from the nerve to the obturator internus, while the inferior gemellus from the nerve to quadratus femoris
5) quadratus femoris: by nerve to the quadratus femoris from the sacral plexus

Front 72

Name the structures exposed by reflection of the quadratus femoris

Back 72

1) tendon of the obturator externus
2) medial circumflex femoral artery (its ascending branch)

Front 73

give the relations of the posterior cutaneous nerve of the thigh to the sciatic nerve

Back 73

- it runs in company with the sciatic nerve in the gluteal region
- it is separated from the sciatic nerve in the thigh by the long head of the biceps femoris

Front 74

what are the bony relations of the sciatic nerve

Back 74

1) as it leaves the greater sciatic foramen it lies directly on the back of the ischium
2) as it descends it lies midway between the greater trochanter and ischial tuberosity (this site should be avoided in giving intramuscular injections)

Front 75

describe the relations of the femoral nerve and femoral vessels to the femoral sheath

Back 75

-the nerve lies outside the sheath behind its posterior wall
- on the other hand, the femoral artery and vein lie inside the sehath, in the lateral and middle compartments respectively

Front 76

what are the boundaries of the femoral ring? give its surgical importance

Back 76

-Medially: free edge of the lacunar ligament
- Anteriorly: inguinal ligament
- Laterally: femoral vein
- Posteriorly: pectineal line (pecten pubis)

The femoral ring transmits the femoral hernia whose neck lies below and lateral to the pubic tubercle

Front 77

what are the relations of the femoral artery to the neighbouring nerves

Back 77

1) femoral nerve: lateral to the artery, just below the inguinal ligament
2) saphenous nerve and nerve to the bastus medialis: lateral to the artery in the femoral triangle
3) the saphenous nerve crosses in front of the artery to come medial to it in the adductor (subsartorial) canal
4) the medial cutaneous nerve of thigh crosses in front of the artery at the apex of the femoral triangle

Front 78

name the sites at which the femoral artery comes in close relation to the femur

Back 78

1) just below the inguinal ligament: it crosses in front of the head of the femur but is separated from it by the iliopsoas muscle
2) in the adductor canal: only separated from the shaft by the vastus medialis
3) at the opening into the adductor magnus: it is in direct contact with the bone with no muscle intervening

Front 79

what is the relation of the femoral vein to the femoral artery?

Back 79

1) just below the inguinal ligament: the vein is medial to the artery
2) in the lower part of the femoral triangle: the vein is posterior to the artery
3) in the adductor canal: the vein is posterolateral to the artery

Front 80

Name the contents of thea dductor (Subsartorial) canal and mention how do they leave it

Back 80

1) femoral vessels: leave the canal through the opening into the adductor magnus to enter the popliteal fossa
2) saphenous nerve: passes into the leg from under cover the sartorius muscle
3) nerve to vastus medialis: enters the muscle in the upper part of the canal

Front 81

give the muscles forming the walls of the adductor canal and give their nerve supply

Back 81

1) adductor longus: by the obturator nerve (posterior wall)
2) adductor magnus: by both the obturator nerve and sciatic nerve (post wall)
3) vastus medialis: by femoral nerve (ant wall)
4) sartorius: by femoral nerve (Roof)

Front 82

give the arrangement of the vessels at the middle of the medial side of the thigh (from anterior to posterior)

Back 82

-femoral artery
-femoral vein
-insertion of the adductor longus
-profunda vein
-profunda artery

Front 83

name the nerve and artery of the medial side of the thigh and give the origin of each

Back 83

the nerve is the obturator nerve while the artery is the profunda femoris artery

the obturator nerve: arises from the lumbar plexus L2,3,4

the profunda artery arises from the femoral artery 2 inches below the inguinal ligament

Front 84

how can you define the anterior and posterior divisions of the obturator nerve

Back 84

-the anterior division: passes above the obturator externus muscle and then in front of the adductor brevis (between it and the adductor longus)
-the posterior division: pierces the upper part of the obturator externus and then passes behind the adductor brevis (between it and the adductor magnus)

Front 85

How do the profunda femoris artery and tis branches leave the femoral tirangle

Back 85

1) lateral circumflex: runs laterally, among the branches of the femoral nerve then behind the sartorius and rectus femoris
2) medial circumflex; runs backwards, between the psoas major and pectineus
3) continuation of the profunda: runs downwards, deep to the insertion of the adductur longus as the 4th perforating artery
4) the perforating branches: pierce the insertion of the adductor magnus to reach the back of the thigh

Front 86

describe the cruciate anastomosis

Back 86

it is formed of:
a) 1st perforating branch of the profunda artery (ascends)
b) inferior gluteal branch of the internal iliac artery (Descends)
c) transverse branches of the medial and lateral circumflex of the profunda artery

-it lies on the back of the upper part of the shaft of the femur and connects the internal iliac artery with the upper part of the femoral artery

Front 87

give the anastomoses into which the profunda femoris shares

Back 87

1) cruciate anastomosis: through the transverse branches of the lateral and medial circumflex and the 1st perforating
2) at the anterior superior iliac spine: through the ascending branch of the lateral circumflex
3) around the knee; through the descending branch of the lateral circumflex
4) on the back of the thigh: between the 4 perforating branches which join the popliteal artery

Front 88

name the tributaries of the femoral vein

Back 88

1) profunda femoris vein
2) medial and lateral circumflex veins (do not end in the profunda vein)
3) great saphenous vein

Front 89

enumerate the vessels that accompany the saphenous and sural nerves

Back 89

1) saphenous nerve:
-femoral vessels above the knee
-great saphenous vein below the knee
2) sural nerve: small saphenous vein

Front 90

describe the arrangement of the main contents of the popliteal fossa

Back 90

1) the popliteal artery: is the deepest structure in contact with the bone
2) the popliteal vein: is superficial to the artery and crosses over from medial to lateral
3) the tibial nerve: is superficial to the vein and crosses over it from lateral to medial
4) the common peroneal nerve: is close to the upper lateral boundary of the fossa

Front 91

Name the sites where you can identify the common peroneal nerve

Back 91

1) where it is partly overlapped by the tendon of the biceps femoris at the upper lateral boundary of the popliteal fossa
2) on the back of the head of the fibula
3) on the lateral side of the neck of hte fibula ( can be felt easily and is very susceptible to injury)

Front 92

name the muscular branches of the tibial nerve

Back 92

1) in the popliteal fossa: to 4 muscles: gastrocnemius, soleus, plantaris and popliteus

2) in the leg: to 4 muscles: soleus (2nd branch), tibialis posterior, flexor digitorum longus and flexor hallucis longus

Front 93

what are the main differences between the fibular collateral and tibial collateral ligaments of the knee

Back 93

1) fibular collateral ligament: cord-like and is separated from the lateral meniscus by the tendon of the popliteus

2) tibial collateral ligament: flat and triangular, and is blended with the capsule of the joint as well as with the medial meniscus

Front 94

name the nerves supplying the skin of the leg

Back 94

saphenous, sural, sural communicating, lateral cutaneous nerve of the calf and superficial peroneal

Front 95

name the nerve supplying the skin of the foot (dorsum and sole)

Back 95

saphenous, sural, superficial, peroneal, deep peroneal, medial plantar and lateral plantar

Front 96

name the retinacula around the ankle

Back 96

1) extensor retinacula (superior and inferior)
2) peroneal retinacula (superior and inferior)
3) flexor retinaculum

Front 97

Give the insertion of the muscles of the extensor compartment of the leg

Back 97

1) tibialis anterior: into the medial cuneiform bone and base of the first metatarsal bone
2) extensor hallucis longus: into the base of the terminal phalanx of the big toe (hallux)
3) extensor digitorum longus: into the extensor expansions of the lateral 4 toes
4) peroneus tertius: int othe base of the 5th metatarsal

Front 98

at which joints do eversion and inversion occur? name the acting muscles

Back 98

-eversion and inversion occur mainly at the subtalar joint (between the talus and calcaneus) and also at the talonavicular joint

-the acting muscles are:
1) eversion: by peroneus longus, peroneus brevis and peroneus tertius
2) inversion: by tibialis anterior and tibialis posterior

Front 99

where can you feel arterial pulsation in the lower limb?

Back 99

1) on the dorsum of the foot: the dorsalis pedis artery is felt just lateral to the extensor hallucis longus
2) behind the medial malleolus (deep to the flexor retinaculum): the posterior tibial artery is felt and even seen pulsating
3) at the midinguinal point: the femoral artery can be felt

Front 100

define cutaneous distribution of the deep peroneal nerve

Back 100

it supplies the only adjacent sides of the 1st and 2nd toes

Front 101

trace the tendon of the insertion of the peroneus longus

Back 101

1) behind the lateral malleolus (lower end of the fibula)
2) on the lateral surface of calcaneus
3) in a groove on the plantar surface of the cuboid
4) in the 4th layer of hte sole
5) inserted into the medial cuneiform and base of the 1st metatarsal bone

Front 102

Name the muscles attached to the base of the 5th metatarsal bone and mention their nerve supply

Back 102

a) dorsal aspect:
1. peroneus tertius: by deep peroneal nerve
2. peroneus brevis: by superficial

b) plantar aspect:
1. abductor digiti minimi: by lateral plantar nerve
2. flexor digiti minimi brevis: by lateral plantar nerve

Front 103

compare the muscular and cutaneous distribution between the superficial and deep peroneal nerves

Back 103

a) superficial peroneal:
-muscular : to 2 muscles only (in the lateral compartment of the leg)
-cutaneous: wide distribution to the leg and foot

b) deep peroneal:
-muscular: to 5 muscles (in the anterior compartment)
-cutaneous: limited distribution to the foot

Front 104

trace the tendon of insertion of the tibialis posterior

Back 104

1) on the back of the medial malleoulus
2) on the deltoid ligament (deep to the flexor retinaculum)
3) below the spring ligament (supports the head of talus)
4) inserted partly in the tuberosity of the navicular bone
5) the other insertion is into all the other tarsal bones except the talus

Front 105

trace the tendon of insertion of the flexor digitorum longus

Back 105

1) on the back of the medial malleolus (just lateral to the tibialis posterior)
2) on the medial side of the sustenaculum tali (deep to the flexor retinaculum)
3) in the 2nd layer of the sole where it crosses below the tendon of the flexor hallucis longus
4) divides into 4 tendons to be inserted into the bases of the distal phalanges of the lateral 4 toes

Front 106

Name the structures d eep to the flexor retinaculum of the ankle

Back 106

1) tendon of tibialis posterior
2) tendon of flexor digitorum longus
3) posterior tibial nerve and vessels
4) tendon of flexor hallucis longus

Front 107

name the structures deep to the extensor retinaculum of the ankle (from medial to lateral)

Back 107

1) tendon of tibialis anterior
2) tendon of extensor hallucis longus
3) anterior tibial nerve and vessels
4) tendon of extensor digitorum longus

Front 108

name the muscles which abduct the hip joint, and give their nerve supply

Back 108

-gluteus medius and minimus
-supplied by the superior gluteal nerve

Front 109

give the attachments and function of the iliofemoral ligament of the hip joint

Back 109

attachments; from the anterior inferior iliac spine to the intertrochanteric line
function: it resists hyperextension of the hip joint

Front 110

give the action of the following muscles: popliteus, tibialis posterior, semimembranosus

Back 110

1) popliteus: flexes the knee and rotates the leg medially. it unlocks the knee.

2) tibialis posterior: inverts the foot and assists in its plantar flexion

3) semimembranosus: flexes the knee and rotates the leg medially

Front 111

name the branches of the posterior tibial artery

Back 111

1) circumflex fibular
2) peroneal
3) nutrient to the tibia
4) medial malleolar (runs towards the medial malleolus)
5) communicating (with the peroneal)
6) calcanean
7) medial and lateral plantar (Terminal)

Front 112

Name the branches of the peroneal artery

Back 112

1) nutrient to the fibula
2) communicating (connects the posterior tibial to the peroneal)
3) perforating (perforates the lower part of the interosseous membrane)
4) calcanean (to the lateral side of the heel)

Front 113

Name the branches of the anterior tibial artery

Back 113

1. anterior tibial recurrent
2. posterior tibial recurrent
3. medial malleolar
4. lateral malleolar

Front 114

describe the axis of abduction and adduction of the toes

Back 114

it passes through the midline of the 2nd toe.

Front 115

trace the course of the lateral plantar artery

Back 115

1) begins under cover of the flexor retinaculum
2) passes laterally between the 1st and 2nd layers of the sole
3) at the base of the 5th metatarsal bone, it changes its directin to run medially and deep between the 3rd and 4th layers of the sole where it is termed the plantar arch
4) at the 1st interosseous space it is joined by the end of the dorsalis pedis artery

Front 116

Name the tendons related to the dorsalis pedis artery

Back 116

1) tendon of extensor hallcuis longus: runs along its medial side
2) tendon of extensor digitorum longus: lies lateral to it
3) tendon of extensor hallucis brevis: crosses superficial to its lower part

Front 117

where can you identify the medial plantar nerve?

Back 117

1) it begins deep to the flexor retinaculum
2) it lies in the interval between the abductor hallucis and flexor digitorum brevis

Front 118

what are the branches of the dorsalis pedis artery?

Back 118

1) lateral and medial tarsal
2) arcuate artery
3) 1st dorsal metatarsal artery

Front 119

Name the muscles supplied by the medial plantar nerve

Back 119

1) abductor hallucis
2) flexor digitorum brevis
3) flexor hallucis brevis
4) 1st lumbrical (most medial)

Front 120

Give the surface anatomy of the femoral artery

Back 120

it is indicated by the upper 2/3 of a line extending from the midinguinal point to the adductor tubercle

Front 121

Describe the surface anatomy of the sciatic nerve

Back 121

it is represented by a line extending between 2 points:
- upper point: midway between the ischial tuberosity and greater trochanter
- lower point: at the middle of the back of the thigh, in its midline

Front 122

what is the surface anatomy of the great saphenous vein in the thigh

Back 122

it is indicated by a line extending from the adductor tubercle to a point 3 cm below and lateral to the pubic tubercle (corresponds to the saphenous opening)

Front 123

give the attachments of the deltoid ligament of the ankle

Back 123

1) above: to the tip of the medial malleolus
2) below: to the talus, navicular, sustenaculum tali and to the spring ligaments
NB it is triangular in shape (delta like)

Front 124

name the components of the 2nd layer of the sole of the foot

Back 124

-tendons; of flexor digitorum longus and flexor hallucis longus
-muscles: flexor accessorius and 4 lumbricals

Front 125

name the muscles of the 1st layer of the sole and give their nerve supply

Back 125

1) abductor hallucis: by medial plantar nerve
2) flexor digitorum brevis: by medial plantar nerve
3) abductor digiti minimi; by lateral plantar nerve

Front 126

Name the arteries sharing in the anastomosis around the ankle

Back 126

1) lateral and medial malleolar branches of the anterior tibial artery
2) tarsal branches of the dorsalis pedis artery
3) calcanean and perforating branches of the peroneal artery
4) calcanean and malleolar branches of the posterior tibial artery

Front 127

Enumerate the arteries sharing in the anastomosis around the knee

Back 127

1) descending geniculate artery (from the femoral artery)
2) descending branch of the lateral circumflex artery (from the profunda femoris)
3) five genicular arteries (From the popliteal)
4) posterior tibial recurrent artery (from the anterior tibial)
5) anterior tibial recurrent artery (from the anterior tibial)
6) circumflex fibular artery (from the posterior tibial)

Front 128

What are the dermatomes of the skin of the thigh

Back 128

-infront : L1,2,3 supply transverse strip from above downwards (L3 at knee)
-on the back: S2 supplies a longitudinal broad strip on the midline of the back of the whole thigh

Front 129

What are the dermatomes of the foot

Back 129

L4: on the big toe and medial part o fthe foot
L5: on the middle 3 toes and middle part of the foot
S1: on the little toe and lateral part of the foot

Front 130

what are the dermatomes of the skin of the leg

Back 130

L4: on the medial surface of the leg
L5: on the lateral surface of the leg
S2: on the posterior surface of the leg extending up to the back of the thigh

Front 131

Give the branches of the femoral artery

Back 131

- 3 superficial branches (Superficial external pudendal, superficial epigastric, superficial circumflex iliac)
- deep external pudendal
-profunda femoris
-descending genicular

Front 132

Give the branches of the profunda femoris artery

Back 132

-lateral circumflex femoral: gives off ascending, transverse and descending branches
- medial circumflex femoral: gives off ascending and transverse branches as well as an acetabular branch to the hip joint
- 4 perforating arteries

Front 133

enumerate the branches of the popliteal artery

Back 133

-2 superior genicular (lateral and medial)
-2 inferior genicular (lateral and medial)
- middle genicular
- 2 terminals (anterior and posterior tibial)

Front 134

Name the branches of the lateral plantar artery

Back 134

-superficial branches
-plantar arch (deep) gives off:
a) 3 perforating arteries
b) 4 plantar metatarsal arteries

Front 135

Name the branches of the medial plantar artery

Back 135

only 3 superficial digital branches

Front 136

Name the muscles supplied by the lateral plantar nerve

Back 136

-flexor accessorius
-abductor digiti minimi
-flexor digiti minimi brevis
-adductor hallucis
-all interosseous muscles
-lateral 3 lumbricals

Front 137

name the muscles supplied by the obturator nerve

Back 137

- anterior divisoin:
1) adductor longus
2) adductor brevis
3) gracilis
4) pectineus

-posterior division
1) obturator externus
2) adductor magnus (pubic part)

Front 138

what are the components of the subsartorial plexus of nerves

Back 138

1) medial cutaneous nerve of the thigh
2) saphenous nerve
3) anterior division of the obturator nerve

Front 139

describe the afferent and efferent drainage of the deep inguinal nodes

Back 139

-afferent drainage from:
1) superficial inguinal nodes
2) deep tissue to the lower limb
-efferent drainage: to the external iliac node