Anatomy Exam 3: Anterior Thigh & Knee Joint

Front 1

What vein may anastomose with the lateral thoracic vein to form a thoracoepigastric vein, which provides a collateral route for blood to return to the heart if either the superior vena cava or the inferior vena cava is blocked?

Back 1

the superficial epigastric vein

Front 2

The terminal portion of what vein may become dilated (saphenous varix) and be
confused with other groin swellings (e.g., a femoral hernia, psoas abscess).

Back 2

the great saphenous vein

Front 3

If valves in perforating veins or in the great saphenous vein itself become incompetent,
blood pools in the ____________ and it becomes tortuous and dilated (varicose veins) .

Back 3

great saphenous vein

Front 4

The presence of valves also means that a segment of the great saphenous vein that is transplanted in coronary artery bypass surgery must be
_________ to allow blood to flow past the site of coronary artery obstruction.

Back 4

reversed

Front 5

Unexplained enlargement of the superficial inguinal lymph nodes (lymphadenopathy) is an indication to do what?

Back 5

examine the
entire field of drainage for possible cancer or infection.

Front 6

(testicular/scrotal) cancer in males, but not (testicular/scrotal) cancer, characteristically metastasizes to the superficial inguinal nodes

Back 6

scrotal cancer not testicular cancer

Front 7

Uterine cancer in females occasionally metastasizes along the____________________ to the labium majus to reach the superficial inguinal nodes.

Back 7

round ligament of the uterus

Front 8

Superiorly, the membranous layer of superficial
abdominal fascia (Scarpa’s fascia) fuses with the fascia lata just below the __________________, preventing the spread into the thigh of extravasated urine from a ruptured penile urethra or other fluids from the lower abdominal wall.

Back 8

inguinal ligament

Front 9

The _____________________ gives attachment to the gluteus maximus and tensor fasciae latae muscles.

Back 9

iliotibial tract

Front 10

The iliotibial tract may be a source of pain at the hip or at the knee, where it causes inflammation due to friction, this is known as what?

Back 10

iliotibial band syndrome

Front 11

The powerful contractions of what muscle may avulse the lesser trochanter in skeletally immature individuals and those with metastatic lesions at
the site?

Back 11

iliopsoas

Front 12

A pyogenic retroperitoneal infection of the posterior abdominal cavity (e.g., tuberculosis of the lumbar vertebral column) may result in a_________ that spreads between the muscle and its fascia (psoas fascia).

Back 12

psoas abscess

Front 13

The psoas abscess passes deep to the inguinal ligament and into the proximal thigh, where it may be mistaken for what (3 things)?

Back 13

a femoral hernia
saphenous varix
enlarged superficial inguinal lymph nodes

Front 14

Due to the iliopsoas muscle’s close relationships to the kidneys and ureters, pancreas, cecum and
appendix within the abdomen, inflammation of any of these structures (e.g., acute appendicits) may cause pain when the patient extends the affected thigh against resistance, what is this referred to as?

Back 14

a positive iliopsoas maneuver or psoas sign

Front 15

What muscle may avulse
the ASIS in skeletally immature individuals?

Back 15

sartorius

Front 16

Following paralysis of the iliopsoas muscle, the tensor fasciae latae may hypertrophy in a largely
futile effort to help ________________________.

Back 16

compensate for weakened hip flexion

Front 17

What muscle may avulse the AIIS in immature athletes?

Back 17

rectus femoris

Front 18

The ____________ nerve’s innervation of both joints provides a path for referred pain from the hip to the
knee; therefore, unexplained knee pain is an indication to examine the hip for problems.

Back 18

femoral nerve

Front 19

Both femoral circumflex arteries supply muscles, but the (medial/lateral) femoral circumflex is
also the major blood supply to the head of the adult femur via its retinacular branches.

Back 19

medial femoral circumflex artery

Front 20

Interruption of the blood supply to the femoral head by a fracture of the femoral neck frequently results in avascular necrosis of the femoral head and necessitates hip replacement surgery. This fracture is common in what group of individuals?

Back 20

common in postmenopausal women with osteoporosis

Front 21

Both femoral circumflex arteries also participate with the inferior gluteal and first perforating arteries in what?

Back 21

cruciate anastomosis

Front 22

A femoral pulse is easily taken in a supine patient just inferior to the inguinal ligament, midway between the _____ and ______________.

Back 22

between the ASIS and pubic tubercle

Front 23

The femoral artery may be compressed
posteriorly against the ____________ and ___________ through the overlying iliopsoas muscle to control bleeding from the lower extremity.

Back 23

superior pubic ramus and femoral head

Front 24

Femoral or popliteal laceration may cause rapid exsanguination. If both the femoral artery and vein are lacerated, what may form?

Back 24

an arteriovenous shunt

Front 25

The _________ artery is readily accessible for cannulation for cardiac angiography, for arterial blood sampling, and continuous blood pressure monitoring

Back 25

femoral artery

Front 26

What vein may be cannulated to access the right side of the heart or to administer
intravenous fluids?

Back 26

the femoral vein

Front 27

The hip joint may be seeded with infection that may destroy the joint (septic arthritis) during _________________due to poor technique.

Back 27

femoral venipuncture

Front 28

The femoral vein is a deep vein and may be a site of deep venous thrombosis, the most common source of ______________________. Massive
pulmonary embolism is the second leading cause of sudden death.

Back 28

pulmonary thromboemboli

Front 29

In a femoral hernia, which is more common in females, a loop of intestine or other viscera protrudes through the_________from the abdominal cavity.

Back 29

femoral ring

Front 30

The femoral hernia is covered by peritoneum and extraperitoneal connective tissue and may escape through the __________ into superficial fascia of the thigh.

Back 30

saphenous opening

Front 31

Femoral hernias are distinguished from inguinal hernias by the protrusion being (superior/inferior) and (medial/lateral) to the pubic tubercle rather than superior to it.

Back 31

inferior and lateral to pubic tubercle

Front 32

Femoral hernias are in danger of incarceration and of strangulation by the ________________at the femoral ring and by the sharp falciform margin at the saphenous opening.

Back 32

lacunar ligament

Front 33

Because the __________ bursa is continuous with the synovial joint cavity, infection in either space easily spreads to the other.

Back 33

suprapatellar bursa

Front 34

The suprapatellar bursa also can accommodate a large amount of joint effusion during ________________and may mask the swelling characteristic of inflammation unless the bursa is “milked” downward toward the joint cavity.

Back 34

synovitis of the knee joint

Front 35

The deep fibers of the tibial collateral ligament firmly attach to the medial meniscus, making the meniscus relatively immobile. Therefore, injury to the tibial collateral ligament typically is accompanied by what?

Back 35

injury to the medial meniscus

Front 36

The ___________________ is often injured together with the tibial collateral ligament and medial meniscus as part of the unhappy triad of athletic knee injuries.

Back 36

anterior cruciate ligament

Front 37

The most common injuries to the knee joint are _______________. A blow to the lateral side of the knee (e.g., a tackle in football) produces a valgus stress, often tearing the _________________ ligament.

Back 37

ligament sprains

tibial collateral ligament

Front 38

A blow to the medial side of the knee produces a less common varus stress that stretches
and may tear the ___________________________.
Since the ligament has no attachment to
the lateral meniscus, the meniscus typically is not torn with it.

Back 38

fibular collateral ligament

Front 39

The _________________ nerve may be injured during a severe varus stress and should be examined along with the fibular collateral ligament.

Back 39

common fibular nerve

Front 40

The ACL may be sprained by different mechanisms, but they often involve a rapid change of direction (rotation of the femur on the tibia) with the foot firmly planted and/or a blow to the knee. What is a common mechanism for ACL sprain?

Back 40

knee valgus with external tibial rotation

Front 41

Acute extravasation of blood into the joint cavity (hemarthrosis) is common. If the anterior cruciate ligament is torn, the flexed tibia can be pulled forward on the fixed femur. This is known as what?

Back 41

anterior drawer sign

Front 42

If the stronger PCL is torn, the flexed tibia can be pulled backward on the fixed femur by the examiner, known as what?
The posterior cruciate may be injured when the upper tibia of an unrestrained front seat passenger strikes the dashboard of an auto during a collision

Back 42

posterior drawer sign)

Front 43

Meniscal tears usually involve the medial meniscus rather than the more mobile lateral meniscus. Injury commonly involves _________________ or___________________ during weight-bearing.

Back 43

flexion-rotation or extension rotation

Front 44

Symptoms of meniscal tears include ____________, ___________, or__________________.
Effusion or hemarthrosis may be present.

Back 44

joint line pain, popping, catching, and locking

Front 45

Only the ____________ of the adult meniscus has a vascular supply and, therefore, a capacity for healing. Injury to the inner two-thirds of a meniscus may require surgical repair or removal of part or all of the meniscus. Efforts are made to spare (or transplant) a meniscus if possible because the concentrated weight on the femoral and tibial articular surfaces following meniscectomy predisposes to the early development of what?

Back 45

peripheral third



osteoarthritis

Front 46

Injuries of the (extensor/flexor) mechanism of the knee include rupture of the quadriceps tendon, rupture of the patellar ligament, patellar fracture, and patellar dislocation.

Back 46

extensor

Front 47

Rupture of the quadriceps tendon typically occurs over the age of 40 years following a preexisting condition that weakens the tendon, such as tendinitis. Quadriceps rupture results in what?

Back 47

inability to extend the knee, with a gap developing in the suprapatellar region during the attempt

Front 48

Rupture of the patellar ligament (patellar tendon) usually occurs in individuals younger that 40. Active knee extension is lost and the patella rides high
(patella alta) because it has lost its anchor to the _____________.

Back 48

tibial tuberosity

Front 49

Transverse fractures of the patella often result from forceful contraction of the _____________muscle against resistance. The fracture is typically
near the middle of the patella, and the proximal fragment is displaced (upward/downward) by the pull of the muscle. What action is lost?

Back 49

quadriceps femoris muscle

upward

Active extension is lost and the defect in the bone may be palpable.

Front 50

Comminuted fractures of the patella result from direct trauma, and the fragments often remain nondisplaced. Occasionally the fractured patella must be excised, which means that a much stronger ________________ is necessary to extend the knee with the same force due to the loss of mechanical advantage.

Back 50

quadriceps femoris

Front 51

Fractures of the patella must be differentiated from normal variations in patellar structure resulting from ___________________ (e.g., bipartite patella).

Back 51

lack of fusion of secondary ossification centers

Front 52

The patella may partially dislocate (sublux) or fully dislocate from its articulation with the groove on the patellar surface of the_______as a result of trauma or congenital factors.

Back 52

femur

Front 53

Patellar dislocation is almost always (lateral/medial) and occurs more frequently in females due to
the larger Q angle (formed by a line drawn between the ASIS and middle of the patella and a line drawn from the center of the patella through the tibial tubercle).

Back 53

lateral

Front 54

Other factors that predispose to lateral subluxation include a shorter anterior projection of the lateral femoral condyle and a weak ___________________.

Back 54

vastus medialis obliquus

Front 55

Self-reduction of the dislocated patella usually occurs, but the patient shows a (positive/negative) patellar apprehension sign if the examiner pushes the patella laterally with the knee of the supported extremity flexed to 30° or so.

Back 55

positive

Front 56

There are a number of bursae associated with the knee region. The knee bursa most commonly inflamed overlies the patella and is subject to repeated friction, producing inflammation, this is known as what?

Back 56

prepatellar bursitis or “housemaid’s knee”

Front 57

There are superficial and deep infrapatellar bursae related to the patellar ligament. Superficial
infrapatellar bursitis may be confused with Osgood-Schlatter disease. Anserine bursitis involving the pes anserinus bursa may be confused with what injury?

Back 57

a tibial collateral ligament injury

Front 58

On the posterior aspect of the knee, the semimembranosus bursa between the medial
head of the gastrocnemius and the semimembranosus tendon may become inflamed to form a _____________. This bursa usually
communicates with the synovial cavity of the knee joint and may enlarge when the knee
joint becomes inflamed (e.g., in rheumatoid arthritis).

Back 58

Baker’s (popliteal) cyst

Front 59

Rarely, a Baker’s cyst may become large enough to interfere with knee flexion or compress popliteal neurovascular structures. If the cyst ruptures, irritating fluid enters the posterior compartment of the leg and may cause symptoms resembling what?

Back 59

thrombophlebitis