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Hip and thigh1. Femoral nervea. is less subject to damage by penetrating injuries of the lower abdomen than of the lower limb – would imagine most susceptible in femoral triangle… but?b. Damage may cause anaesthesia of the foot - terminal branch of femoral is the saphenous which supplies lateral leg and foot. Most of the foot is from the terminal branches of the sciatic (tibial -> medical calcaneal, lateral and medial plantar for the sole, and superficial fibular for the dorsum)c. Is contained within the femoral sheath – no lateral to and outside ofd. Is formed by the anterior divisions of L2,3,4 – posterior divisions of (embryologically rotates)e. Gives a single muscular branch to iliacus <= it does supply iliacus via a single branch2. With respect to the hip jointa. The fibrous capsule is strengthened by 2 ligaments – no 3, iliofemoral, ishiofemoral and tuberofemoralb. Anteriorly the psoas major tendon separates the capsule from the femoral vein – the psoas muscle itself forms the floor of the femoral triangle with the artery anterior – the vein is lateral to that. The tendon itself is inferior to the head as it inserts into the lesser trochanterc. It is least stable when flexed and adducted <= flexion unwinds the ligaments, d. Ligament of Bigelow is the weakest ligament – aka iliofemoral, is the strongeste. Ischiofemoral ligament is the strongest ligament – no the iliofemoral is3. Femoral nervea. Is formed from the anterior divisions of the anterior primary rami of L2-4 – no posterior (obturator is anterior divisions)b. Is formed from the same spinal segments as the obturator nerve <= truec. Divides after passing through the femoral triangle – no branches of the femoral nerve are in the triangle and it enters the subsatorial as the saphenous nerved. Has no cutaneous branches other than the saphenous nerve – no it has anterior cutaneous branches that arise in the femoral triangle, and pierce the fascia lata along the path of satoriuse. Enters the thigh in the femoral sheath – no outside and lateral to4. Which of the following does not pass through the greater sciatic foramena. The sciatic nerveb. The pudendal nerve and vesselsc. The posterior cutaneous nerve of the thighd. Inferior gluteal vessels and nervee. Nerve to obturator externus <= the nerve to obturator internus does (then passes back into the lesser to supply the muscle along with the pudendal nerve and vessels). The obturator externus is an adductor and therefore supplied by the obturator nerve5. Which of the following are not found in the adductor (subsartorial) canala. Femoral arteryb. Femoral veinc. Femoral nerve <= saphenous on leaving the femoral triangle and through the adductor canal (note from lateral to medial over the artery, the artery is always between the nerve and vein, the vein from medial to posterior at the hiatus)d. Saphenous nerve e. Nerve to vastus medialis6. A 30 y.o. man presents with adenopathy of the medial group of superficial inguinal lymph nodes on the right side. Which of the following is the primary site resulting in this finding?a. Right testis – no the right testis drains to paraaortic nodesb. Right buttockc. Skin of lower limb – indicated answer but Moore’s states “the field of drainage of inguinal lymph nodes is from umbilicus down”d. Anal canal – the lower part e. None of the above 7. Following a subcapital fracture of the neck of femur, an 80 y.o. man sustains avascular necrosis of the femoral head. This is most likely to be the consequence of interruption to the blood supply to the head from which of the following sources?a. Arteries from the trochanteric anastomoses in the retinacula <= this is the main supply, the medial circumflex from the femoral providing the most inputb. Artery of the ligament of the head from the obturator arteryc. Branches from the profunda femoris arteryd. Branches from the pudendal arterye. Branches from the inferior gluteal artery8. The muscle which provides the most control of hip joint movement during the act of sitting isa. Iliacusb. Semitendonosisc. Semimembranosisd. Gluteus maximus <= strong extensore. Gluteus minimis9. Which of the following are correctly paired?a. Adductor brevis – femoral nerve - ant div of obturatorb. Adductor longus – sciatic nerve- ant div of obturatorc. Adductor magnus – saphenous nerve- adductor part: obturator, hamstring part: tibial from sciaticd. Adductor longus – obturator nerve<= correcte. Adductor magnus – femoral nerve- adductor part: obturator, hamstring part: tibial from sciatic 10. The great saphenous veina. Is a continuation of the lateral marginal vein of the foot - smallb. Runs between the 2 heads of gastrocnemius - smallc. Pierces the cribriform fascia in the upper thigh <= correctd. Can be found immediately below and lateral to the pubic tubercle – 3.75 cm x 3.75 cme. Does not communicate with varicosities in the superficial veins – it does11. With regard to the femoral trianglea. It is bounded by adductor longus and magnus – medial sartorius and medial adductor longusb. It has the fascia lata lining it s floor – as it’s roofc. The femoral artery lies between the femoral vein and nerve <= true! (NAVeL)d. It is bounded superficially by the lacunar ligament – superiorly by the inguinale. The femoral sheath contains only the femoral nerve and artery – the vein and artery12. The femoral arterya. Is separated from the hip joint capsule by fat only – by psoasb. Is crossed by the femoral vein from medial to lateral as it descends – noc. Is found at the mid-inguinal point <= trued. Gives off the medial circumflex femoral artery as its major branch – no the deep artery of the thigh13. Gluteus maximusa. Is the deepest of the gluteal muscles – nope, most superficialb. Forms the skin crease of the gluteal fold <= it is located just superior to according to Moore’s, and the fold reduces with atrophy of the glut max…c. Is supplied by L5, S1 – via the inferior gluteal n. L5, S1 and S2 (medius and minimus L5 and S1)d. Medially rotates and extends the hip joint – extends and assists lateral rotation and rising from sittinge. All of the above14. Regarding the lymphatic drainage of the lower limba. It is predominantly along the route of the small saphenous vein – no, only from lateral and posterior legb. Apart from a small area of skin over the heel it drains via the popliteal lymph nodes from below the knee – no, lateral foot to posterior leg to popliteal, medial foot to anterior (w/ great saphenous) to inguinalc. From the superficial inguinal lymph nodes it passes through the cribriform fascia to the deep inguinal nodes <= trued. Deep lymphatics follow veins – true alsoe. None of the above15. The femoral nervea. Has superficial branches, one of which supplies the hip joint – not from a superficial branch?b. Supplies psoas major – no, it does give a single muscular branch to iliacusc. Lies within the femoral sheath – no, outside and lateral tod. Emerges from the medial side of psoas major – originates within psoas in the abdomen, emerges lower part of lateral bordere. Is formed from the posterior divisions of the ventral rami of L2,3,4 <= true16. Regarding the femoral veina. It receives the great saphenous vein on its anterolateral surface – anteromedialb. It drains into the internal iliac vein – the external iliacc. It lies lateral to the femoral artery within the femoral sheath – medial tod. It has no valves – it has plenty (10-14)e. It enters the inferior part of the femoral triangle posterior to the femoral artery <= true17. Contents of the femoral triangle include all excepta. Genital branch of the genitofemoral nerve <= decends superficial to the fasciab. Great saphenous vein - truec. Pectineus – true, the floord. Profunda femoris artery - truee. Anterior division of the obturator nerve – possibly on obturator externus18. The adductor canala. Is bounded by adductor brevis - boundaries are: lateral: vastus medialis, medial: adductor longus and magnus. Roof: fascia, Sartorius, subsartorial plexus (ant branch of obturator, medial cutaneous n of thigh and saphenous n – supplies skin of medial thigh)b. Lies behind Sartorius <= true, aka the sub-sartorialc. Contains the femoral nerve – it contains the saphenous nerved. Commences just below the inguinal ligament – nope, that’s the femoral trianglee. Contains the femoral artery which lies inferolaterally to the femoral vein in the lower part – the vein is medial in femoral triangle to posterior in canal19. The obturator nervea. Emerges on the lateral border of psoas – medial borderb. Supplies obturator externus, adductor longus and the knee joint <= the knee is supplied by femoral, tibial and common fibular, as well as obturator and saphenous to medial sidec. Supplies obturator internus, adductor magnus and the hip joint – obturator internus has it’s own nerved. Runs inferior to the obturator artery in the obturator canal - ?e. All of the above20. The femoral nervea. Has an anterior division which supplies skin on the antero-medial surface of the thigh <= it does give cutaneous branches that supply the skin over anteromedial thighb. Runs medial to the femoral artery at the level of the inguinal canal – lateral toc. Has the sural nerve as the terminal branch - saphenousd. Supplies the posterior half of adductor magnus – no the tibial part of sciatic supplies the hamstring parte. Supplies pectineus via its posterior division - pectinueus is supplied by the obturator n. and femoral nerve ?division21. With regard to the head of the femura. The arterial supply comes mainly from the inferior gluteal artery – nope, mainly from the medial circumflex -> trochanteric anastomoses (nb the artery to the head is from the obturator)b. The artery to the head assumes importance after age of 7 years - nopec. Psoas lies posterior to the hip joint – nope, anteriord. The anterior division of the obturator nerve gives partial supply to the hip joint <= should do according to Hilton’s lawe. None of the above22. Regarding the bony pelvisa. The obturator groove is in the ischial bone - pubicb. The greater sciatic foramen transmits the obturator internus - piriformisc. The pectineal line lies superior to the acetabulum - inferiord. The inguinal ligament inserts medially into the iliopubic eminence – pubic tubeclee. None of the above <=23. The hip jointa. Is directed slightly forward along the axis of the femoral neck – true?b. Is supplied by the femoral and obturator nerves only – also the superior glutealc. Has an articular surface which does not reach the rim of the acetabulum <= true, ?, the missing part is the acetabular notch bridged by the transverse acetabular ligamentd. Bears weight mainly through the ischial bone – weight bearing done by iliume. Has a capsule which is strengthened anteriorly by the ischiofemoral ligament – the iliofemoral24. The femoral trianglea. Has sartorius as its medial border - lateralb. Contains the posterior division of the obturator nerve – perhaps the anteriorc. Contains femoral nerve and vessels <= trued. Has the lateral border of adductor longus laterally – no medial bordere. All of the above25. The muscles supplied by the femoral nerve include all excepta. Sartoriusb. Iliacusc. Psoas major <= this is supplied by lumbar ramid. Pectineuse. Rectus femoris26. Concerning the origins of the quadriceps femorisa. All 4 component muscles have an origin from the femurb. Vastus lateralis arises from the femur above intertrochanteric line and acetabulumc. Vastus medialis arises from femur and tendon of adductor longusd. Rectus femoris arises from 3 headse. Vastus intermedius arises from shaft of femur and greater trochanter <=27. The floor of the femoral triangle consists of all of the following excepta. Psoasb. Iliacusc. Pectineusd. Adductor brevise. Adductor magnus <=28. Concerning iliacusa. It inserts into the greater trochanter of the femur - lesserb. It occupies and is attached to the whole of the iliac fossa c. Nerve supply is femoral nerve <=d. It acts to flex and laterally rotate the hipe. It has the femoral vein as its intermediate anterior relation – artery, the vein is lateral29. Psoas majora. Has a proximal attachment to the bodies discs and transverse processes of lumbar vertebraeb. Has the lumbar plexus embedded within itc. Has the lumbar arterie sand veins running behind itd. Inserts into the lesser trochantere. All of the above <=30. Sartoriusa. Arises from the ilium below the ASIS <= and the ASIS itselfb. Is pierced by the lateral cutaneous nerve of the thigh - anteriorc. Inserts into the styloid of the fibulad. Is supplied by the obturator nervee. Flexes and medially rotates the thigh – felx and laterally rotates31. Following Hiltons law, which nerve does not supply the hip jointa. Sciaticb. Obturatorc. Inferior gluteal <= strange given Glut max is the chief extensor!d. Nerve to rectus femorise. Femoral32. branches of femoral artery????33. Superficial inguinal lymph nodes drain all of the following excepta. Anterior thighb. Base of penisc. Testis <= paraaortic34. What goes through the lesser sciatic foramen?a. Piriformisb. Pudendal nerve <=c. Internal pudendal artery <= this does tood. Superior gluteal arterye. Inferior gluteal artery35. Adductor magnus isa. A bipennate muscleb. A component of the femoral trianglec. Supplied by the femoral nerved. A composite muscle <=e. Attached by point of origin to the pectineal line of the pubic bone – body of pubis36. Regarding the femoral artery and its branchesa. Lies lateral to femoral sheathb. Femoral artery has three branchesc. Profunda femoris artery lies anterior to the profunda veind. The 4 perforating arteries supply all thigh musclese. The profunda femoris artery supplies all anterior thigh muscles <=37. Regarding the inguinal canala. It has a roof formed by lower edges of internal oblique and transversus muscles <=b. The ilioinguinal nerve enters the canal through the deep ringc. Its posterior wall is formed by the external oblique aponeurosisd. Its conjoint tendon lies anterior to the superficial inguinal ringe. The superior epigastric artery crosses the posterior wall medial to the deep inguinal ring38. Which of the following muscles is not in the floor of the femoral trianglea. Pectineusb. Adductor longusc. Sartorius <=d. Psoase. Iliacus39. Regarding movements of the hip jointa. Stability is reduced by the presence of the long femoral neckb. Medial rotation is achieved by obturator externus – lateral + steadies the head in the acetabulum, medial rotation is glut medius and minimus, also pectineusc. Sartorius is a lateral rotator <= but the main lateral rotators are deep gluteal muscles: piriformis, obturator internus, superior glemelli (ischial spine, nerve to OI), inferior glemelli (ischial tuberosity, nerve to QF), and quadratus femoris d. Medial rotation is resisted by the iliotibial tract – assisted?e. Abduction is not usually required in normal walking40. Pectineusa. Arises from part of the obturator membrane – sup ramus to pectineal lineb. Is inserted into the greater trochanter – inferior to lesserc. Lies posterior to the anterior division of the obturator nerve anterior tod. Forms one wall of the femoral ring <= post = pectineal lig, ant inguinal, med lacunar, lat fibrous septum medial side of fem veine. Is a lateral rotator of the femur - medial41. The femoral nervea. Supplies the skin over the lateral thigh – anteromedb. Lies between the pectineus and psoas in the femoral trianglec. Is formed by the posterior divisions of the anterior rami of lumbar nerves 2,3 and 4 <= ventral ramid. Breaks into superficial and deep branches, separated by the medial circumflex femoral arterye. Supplies the adductor muscles42. The sciatic nervea. Lies on the ischial tuberosityb. Lies on the obturator internus <=c. Passes upper quadratus femorisd. Emerges from above piriformis - 87% both below, 12% the CF pierces, 0.5% CF abovee. Is comprised of L4, L5, S1, S2 – S123L4543. The medial compartment of the thigh contains all of the following excepta. The obturator nerveb. Obturator arteryc. Gracilis muscled. Obturator internus <= this is a deep gluteal musclee. Obturator externus 44. Adductor magnusa. Is a composite muscle <=b. Has a hamstring part arising from ischiopubic ramus – adductor partc. Has an adductor part arising from ischial tuberosity – hamstring partd. Has a tendinous attachment only onto adductor tubercle of femure. Has a nerve supply including the sciatic and anterior division of obturator nerves – posterior division and sciatic nerve (the anterior division of the obturator supplies add longus and brevis)45. The skin over the femoral triangle is supplied bya. Ilioinguinal nerveb. Obturator nervec. Medial femoral cutaneous nerved. Lateral femoral cutaneous nervee. Genitofemoral nerve <= best answer is femoral branch of genitofemoral, but this is lateral and the ilioinguinal supplies some of the medial46. The great saphenous veina. Is a continuation of the lateral marginal vein of the footb. Runs between the 2 heads of gastrocnemiusc. Pierces the cribriform fascia in the upper thigh <=d. Can be found immediately below and lateral to the pubic tuberclee. Does not communicate with varicosities in the superficial veins47. The hip jointa. Derives its stability largely from the shape of its articular surfaces <=b. Has the ischiofemoral as its strongest ligamentc. Is only supplied by the obturator and sciatic nervesd. Is limited in full extension by the pubofemoral ligament – iliofemoral (the strongest ligament)e. Is flexed largely by sartorius and rectus femoris – main flexor is iliopsoas ................
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