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UTSW anatomy final
thorax, abdomen & lower extremities
| Question | Answer |
|---|---|
| Which ribs are true, false, and floating? | true ribs = 1-7 (articulate with sternum via individual costal cartilages), false ribs = 8-10 (articulate w/sternum through common cartilage), floating ribs = 11-12, do not articulate w/sternum OR each other) |
| What is the difference between visceral and parietal pleura? | Visceral Pleura = over lungs, Parietal pleura = over pleural cavities (costal + diaphragmatic) |
| What structure enters the costomediastinal recess when the lung is fully inflated? | Lingula of the left lung |
| Where is the costal pleura continuous with the diaphragmatic pleura? | costodiaphragmatic reflection |
| What is the crest of cartilage inferior to the main bronchi? | carina |
| What is the region of lung where structures enter & exit? | hilum |
| What is the position of the pulmonary artery in the hilum of each lung? | Right: anterior to the bronchi, Left: superior to the bronchi |
| Which lobe takes up the majority of the posterior side of each lung? | Right: inferior lobe, Left: superior lobe |
| What is the imaginary line along which all the heart valves align, and what is the order of the valves from right to left? | Line from the right 3d rib at the sternum to the left intervertebral space inferior to the 4th rib. Order = pulmonary valve, aortic valve, bicuspid, tricuspid |
| Which arteries are branches of the right coronary artery? | Marginal Branch, Posterior interventricular Artery |
| Which arteries branch off of the left coronary artery? | Circumflex Branch, Anterior Interventricular Artery |
| Which vessel runs in the atrioventricular groove of the heart? | Small cardiac vein |
| Where is the major vein of the heart? | Coronary sinus is located posterior on the heart, inferior to the pulmonary veins, empties into the right atrium directly |
| Which cardiac veins branch off of the coronary sinus? | Small Cardiac Vein runs anteriorly around the right ventricle. Middle CV runs posteriorly along the interventricular groove & over the apex. Great Cardiac Vein runs anteriorly along the interventricular groove to anastamose with the Middle CV. |
| Which cardiac veins do not branch from the coronary sinus? | Anterior Cardiac Veins (bridge the atrioventricular groove @ the right atrium & supply the right atrium directly!) |
| At which point does blood run in the same direction in an adjacent artery and vein? | Great Cardiac Vein + Circumflex branch of the Left Coronary Artery |
| Which artery supplies the SA and AV nodes?? | Sinoatrial Nodal Artery (branch of Right, or Left Coronary Artery), Atrioventricular Nodal Artery (largest branch of posterior Intraventricular branch of Right Coronary artery) |
| What is the purpose of the fibrous skeleton of the heart? | Keeps the orifices open against pressure from blood flow |
| Where is the septomarginal trabecula located and what is its purpose? | Muscular bulge extending between the interventricular septum and the base of the anterior papillary muscle. Prevents opening of mitral valve due to back pressure, carries fibers from right bundle branch to papillary muscles. |
| What is the difference between pectinate muscle and trabeculae carnae? | Only that pectinate muscle is found in the atria and trabeculae carnae in the ventricles. |
| Why is there no septomarginal trabecula in the left ventricle? | The left fiber bundle is close enough to the papillary muscles to innervate them directly. |
| Describe electrical conduction in the heart | SA node -> both atria -> AV node ->AV bundle (of His; contains Purkinje fibers) -> left & right bundle branches (--> septomarginal trabeculae) |
| Where are the SA node & AV node? | SA = sinus venarum just superior to the crista terminalis. AV = posterior part of interatriul septum, just superior to the opening of the coronary sinus. |
| Which region of the atrium contains the christa terminalus, and which contains the fossa ovalis? | Christa terminalus in the true atrium, fossa ovalis in the sinus venarum (smooth region) |
| What supplies the autonomic inputs to the heart? Which dermatomes reflect sensation? | Sympathetic = sympathetic trunks. Parasympathetic = Vagus. Dermatomes = T1-T4. |
| What makes the LUB sound and what makes the DUB sound of the heart? | LUB = AV valves close due to high ventricular pressure, DUB = semilunar valves close due to low ventricular pressure |
| Where is it best to auscultate the AV valves? | Tricuspid = 5th intercostal interval to left of sternum. Bicuspid = 5th intercostal interval to left of mid-clavicular line (apex of heart) |
| Where is it best to auscultate the semilunar valves? | Pulmonary = 2nd intercostal interval, left of the sternum. Aortic = 2nd intercostal interval to right of sternum. |
| What is the pathway of deoxygenated blood in the fetus? | LOWER: mixes w/oxygenated blood in the inferior vena cava, travels to right atrium. UPPER: enters superior vena cava, right atrium, right ventricle, pulmonary trunk, ductus arteriosus (skips lungs), umbilical arteries (to placenta to be oxygenated). |
| What is the pathway of oxygenated blood in the fetus? | Umbilical vein, portal vein, ductus venosus (skips liver), inferior vena cava, right atrium, foramen ovale, left atrium, left ventricle. |
| What becomes of the ductus arteriosus after birth? | ligamentum arteriosum between pulmonary trunk & aortic arch |
| What becomes of the ductus venosus after birth? | in embryo, shunts blood flow from umbilical vein to inferior vena cava, bypassing the liver. in adult, becomes ligamentum venosum on the inferior surface of the liver between the caudate and left lobe |
| What is the ligamentum teres? | Remnant of fetal umbilical vein (found in liver). Fetal umbilical artery becomes ligamentum arteriosum. |
| What is abnormal about the 1st rib? | 1st rib = single facet, 2 superior transverse grooves for sublcavian vessels. The grooves are separated by the scalene tubercle & ridge where the anterior scalene attaches. |
| Which ribs have only one facet? | # 1, 10, 11, 12 |
| What is abnormal about the 2nd rib? | Has rough patch = tuberosity for serratus anterior |
| What are the sternal joints? | synchondrosal |
| What are the boundaries of the superior thoracic aperture? | Vertebra T1, ribs 1 & 2, superior border of the manubrium. Oblique downward anteriorly. |
| What passes through the superior thoracic aperture? | (b/tw the superior thoracic cavity & neck) = trachea, esophagus, nerves & vessels of head & neck & upper limbs. |
| What are the boundaries of the inferior thoracic aperture? | = "anatomical thoracic outlet", 12th thoracic vertebrae, ribs 11 & 12, costal cartilages of 7-10, xiphisternal joint. Oblique upward anteriorly. |
| What viscera are contained in the thorax? | stomach, kidney/adrenals, pancreas, spleen, & lower esophagus |
| What type of joint is the costovertebral joint of the head of the rib? | synovial plane joint |
| What type of joint is the costotransverse joint at the tubercle of the rib? | synovial plane joint |
| What type of joint is the costochondral joint? | (@ joint b/tw rib & costal cartilage) primary cartilaginous (hyaline). |
| What type of joint is the interchondral joint? | (b/tw costal cartilage of 6-9th ribs) = synovial plane joint w/ interchondral ligaments |
| What type of joint is the manubriosternal joint? | secondary cartilagnous (symphysis) |
| What type of joint is the Xiphisternal joint? | Primary cartilaginous (synchondrosis) |
| What is contained in the middle mediastinum? | (bordered by pericardium) heart, great vessel roots, phrenic nerve & pericardiacophrenic vessels |
| What veins are contained in the superior mediastinum? | (superior to the transthoracic plane, inferior to the thoracic inlet) Superior Vena Cava/Brachiocephalic vein/Azygos vein |
| What arteries are contained in the superior mediastinum? | (superior to the transthoracic plane, inferior to the thoracic inlet) Arch of the Aorta/Brachiocephalic trunk/left common carotid/left subclavian artery |
| What nerves are contained in the superior mediastinum? | Vagus/Phrenic/left recurrent laryngeal nerve |
| What viscera are contained in the superior mediastinum? | thymus, trachea, thoracic duct (lymphatic vessel), esophagus |
| What are the borders of the posterior mediastinum, & its viscera? | transthoracic plane, pericardium & diaphragm, thoracic vertebrae 5-12. Contains esophagus, thoracic duct, lymph glands. |
| What are the vessels of the posterior mediastinum? | thoracic aorta, posterior intercostal arteries, Azygos/Hemiazygos/posterior intercostal veins |
| What are the nerves of the posterior mediastinum? | Vagus, Esophageal plexus (of vagus) anterior vagal trunk (of left vagus), posterior vagal trunk (of right vagus), splanchnic nerves |
| Splanchnic Nerves | Carry autonomic fibers (sympathetic = thoracic, parasympathetic = pelvic) to abdominal viscera, & sensory fibers from viscera. Thoracic = Greater (T5-9), Lesser (T10-11), Least (T12) |
| Path of milk in mammary gland | lobule to lactiferous ducts to lactiferous sinus to nipple |
| Which arteries supply the mammary glands? | Internal thoracic, Intercostal, Lateral thoracic, Thoracoacromial |
| What is the innervation of the mammary glands? | anterior & lateral cutaneous branches of 4th to 6th intercostal nerves |
| Which lymph nodes do the mammary glands drain to? | axillary (75%), parasternal, abdominal |
| Where does lymph enter the venous system? | 1. Thoracic duct @ left internal jugular & left subclavian juncture, 2. Right Lymphatic Duct (from upper right quadrant of body) @ right internal jugular & right subclavian juncture |
| Where are lymph nodes palpable? | inguinal, axillary, and cervical areas |
| Into which lymph nodes does skin drain? | 1. above umbilicus drains into axillary nodes, 2. below umbilicus into inguinal nodes, 3. head & neck into cervical nodes |
| What are the boundaries of the anterior abdominal wall? | xiphoid process, costal margin, iliac crest & pubis |
| What are the transverse planes of the abdomen? | subcostal (inferior border of 10th costal cartilage), transtubercular (tubercles of iliac crest), transpyloric (pylorus of stomach when supine), transumbilical (umbilicus/L3/L4 intervertebral disc) |
| What is found in the hypochondriac (subcostal) regions of the abdomen? | right = liver, left = stomach, spleen |
| What is found in the lumbar regions of the abdomen? | right = ascending colon, left = descending colon |
| What is found in the inguinal/iliac regions of the abdomen? | right = cecum & vermiform appendix, left = descending colon |
| What is found in the epigastric, umbilica, & pubic (hypogastric) regions of the abdomen? | epigastric = stomach & liver, umbilical = transverse colon, pubic/hypogastric = sigmoid colon, rectum, small intestine |
| What are the fascia of the abdomen? | Camper's = outer & fatty (superficial). Scarpa's = inner & membranous (superficial). Transversalis = firm & deep on underside of transversus abdominis. Rectus Sheath = around rectus abdominis except posterior & inferior to the arcuate line. |
| What is the innervation of the rectus abdominis? | ventral primary rami T7-12 |
| Which fascia gives the 6-pack look to a muscular abdomen? | Aponeuroses of the abdominal muscles + Linea Alba |
| Which vessels run posterior to the rectus abdominis? | superior and inferior epigastric vessels |
| Which nerve perforates the transversus abdominis & what does it supply? | Subcostal Nerve (inferior to rib 12, passes under the lateral lumbocostal arch) supplies abdominal musculature and cutaneous anterolateral abdominal wall |
| Which ventral primary rami are sensory to abdominal skin & motor to abdominal muscles? | Thoracoabdominal Nerves T7-T11 |
| Which nerve supplies the internal oblique? | Iliohypogastric (L1) |
| What does the Genitofemoral nerve supply? | L1-2. Genital Branch: cremaster muscle, scrotum/skin of mons pubis & labia major. Femoral Branch: skin of anterior superior thigh. |
| Which nerve supplies the skin of the external genitalia & medial thigh? | Iliolinguinal |
| Which nerve supplies the transversus abdominis? | Ilioinguinal |
| Which dermatome is indicated by the umbilicus? | Umbilicus = dermatome T10 |
| Which artery anastamoses with the superior epigastric artery after piercing the posterior aponeurosis of the Transversus abdominis? | Subcostal Artery (like a posterior intercostal, except located below the 12th rib) & Inferior Epigastric. |
| Which structures wind around the inferior epigastric artery? | The vas deferens, as it leaves the spermatic cord OR the round ligament of the uterus winds around the lateral-posterior inferior epigastric artery |
| What is the branching pattern of the femoral artery? | Femoral artery = continuation of external iliac artery where it enters the femoral triangle behind the inguinal ligament. Splits into the Superficial Epigastric, and the Superficial Circumflex Iliac arteries |
| What constitutes the Median umbilical fold? | From bladder to umbilicus, where parietal peritoneum covers remnant of urachus (median umbilial ligament) |
| What structure covers the Medial Umbilical Ligaments? | Medial Umbilical Folds (Medial Umbilical Ligaments = remnants of the umbilical arteries) |
| What structure covers the inferior epigastric vessels? | Lateral Umbilical Folds. A direct hernia occurs medial to the lateral umbilical fold, whereas an indirect hernia originates lateral to the fold. This later case is due to the lateral position of the deep inguinal ring. |
| What are the borders of the Inguinal Region? | (Groin) anterior superior iliac spine, pubic tubercle. Site of inguinal hernias. |
| Describe the structure that marks the boundary between the anterior abdominal wall & the thigh. | Inguinal ligament (free inferior edge of the external oblique). Connects Anterior Superior Iliac Spine to Pubic Tubercle. Helps form Inguinal Canal. Acts as retinaculum for structures entering anterior thigh. |
| Describe the borders of the inguinal canal: | Superior-lateral opening = deep inguinal ring in transversalis fascia. Inferior-medial opening = Superficial Inguinal Ring in External Oblique Aponeurosis. Roof = fibers from internal oblique & transversus. |
| What structures course through the inguinal canal? | Spermatic Cord (males) OR Round Ligament (females), + inguinal nerve (NOTE ilioinguinal nerve does not pass through the deep inguinal ring, and so is not considered to course through the canal) |
| Describe the tissues of the scrotum: | Anterior abdominal wall specialized into skin & Dartos fascia (inclusdes Dartos smooth muscle). No communication between left & right divisions. |
| What does the Spermatic Cord transport? | Ductus Deferens, Testicular Artery, Artery of Ductus Deferens, Pampiniform Plexus (veins), Autonomic Nerves & Genital branch of Genitofemoral nerve, Lymph vessels |
| What are the coverings of the spermatic cord & testes? | 1. external spermatic fascia (continuation of external oblique aponeurosis), 2. Cremaster Muscle (continuation of internal oblique), 3. Internal Spermatic Fascia (Continuation of Transversalis Fascia). |
| Which artery supplies the testes? | Testicular artery (branches directly from thoracic aorta) |
| What is the pathway for sperm? | 1. Seminiferous Tubules (formed), 2. Rete Testis, 3. Efferent Ductules, 4. Epididymus, |
| Describe the structure of the Tunica Albuginea: | = capsule of testes. Visceral Layer covers epididymis, distal ductus deferens, most of testes. Parietal Layer covers anterior 2/3 of testes. Contains septa separating blocks of seminiferous tubules. |
| What is the structure of the Epididymis? | Head = lobules (coiled ends of efferent ductules), 2. Body = coiled duct, 3. Tail = continuous w/ducus deferens |
| What is the lymphatic drainage of the scrotum & testes? | Scrotum to Superficial Inguinal, testes to Deep Abdominal lymph nodes |
| Describe the descent of the testes & ovaries: | 1. start between posterior abdominal wall & peritoneum, 2. Pulled inferiorly by shortening of the gubernaculum, 3. ovary stop @ pelvic brim, testes continue posterior to the processus vaginali into scrotum |
| What does the gubernaculum persist as? | (folds of peritoneum in the abdomen that guide descent of the testes/ovaries). In males, persists as scrotal ligament. In females, persists as round ligament of the uterus & proper ligament of the ovaries. |
| What is a Direct/Acquired Inguinal Hernia? | Projection into superficial inguinal ring directly through the body wall, medial to the Inferior Epigastric Artery. Often through Hesselbach's Triangle. |
| What is an Indirect/Congenital Inguinal Hernia? | Herniation through the inguinal canal into the scrotum (along the Processus Vaginalis, which should have fused shut). Exits lateral to the Inferior Epigastric Artery. |
| What is the Processus Vaginalis? | Evagination of the perioneum into the scrotum/labia majora. Normally closes except for part covering anterior surface of the testis (Tunica Vaginalis). |
| What are the anterior abdominal wall structures from shallow to deep? | Skin, Superficial Fascia (Camper's + Scarpa's), External Abdominal Oblique aponeurosis+fascia, Internal Abdominal Oblique Muscle+Fascia, Transversus Abdominis aponeurosis+muscle+fascia, Transversalis Fascia, Extraperiotneal Fat, Peritoneum |
| What are the scrotal & spermatic cord + testes layers from shallow to deep? | Skin, Dartos Muscle+Fascia, External Spermatic Fascia, Cremaster+Fascia, Internal Spermatic Fascia, Tunica Vaginalis (visceral+parietal) |
| Which arteries supply the right ventricular papillary muscles? | postero-lateral = RCA, antero-medial = LCA |
| What is the Dartos fascia derived from? | Scarpa's fascia (deep to Camper's fascia) |
| What are the borders of Hesselbach's Triangle? | Inferior epigastric vessels, lateral border of the rectus abdominis, and inguinal ligament |
| What is the order of tissues penetrated by a wound lateral and superior to the arcuate line? | Camper's & Scarpa's Fascia, external oblique & fascia, internal oblique & fascia, transversus abdominis & fascia, transversalis fascia, extraperitoneal fat, peritoneum |
| What is the order of tissues penetrated by a wound lateral & inferior to the arcuate line? | Camper's & Scarpa's Fascia, external oblique aponeurosis, internal oblique & fascia, transversus abdominis & fascia, transversalis fascia, extraperitoneal fat, peritoneum |
| What is the order of tissues penetrated by a wound medial and superior to the arcuate line? | Camper's & Scarpa's Fascia, aponeurosis of the external & internal oblique, rectus abdominis & sheath, aponeurosis of the internal oblique, aponeurosis of the transversus abdominis, transversalis fascia. |
| What is the order of tissues penetrated by a wound medial and inferior to the arcuate line? | Camper's & Scarpa's Fascia, aponeurosis of the external & internal oblique, aponeurosis of the internal oblique, aponeurosis of the transversus abdominis, rectus abdominis, transversalis fascia. |
| falciform ligament | "sickle-shaped" ligament in the liver. Free edge contains ligamentum teres. |
| greater omentum | largest peritoneal fold. 2 sheets folded in half = 4 layers. Enclose the transverse colon. Lies inferior to the stomach, along the greater curvature. |
| lesser omentum | connects liver with the lesser curvature of the stomach. 2 layers. |
| Where is the pancreas located? | deep to the transverse colon & stomach, with its head in the C-loop of the duodenum & its tail pointing towards the spleen. |
| What divides the liver into left and right lobes? | (anteriorly) falciform ligament & ligamentum teres |
| Where does the ligamentum venosum run? | between the left lobe & the caudate lobe of the liver |
| where does the portal tirad enter hte liver? | (bile duct, hepatic artery, portal vein) enter @ the porta hepatis, via the hepatoduodenal ligament |
| Describe the drainage of bile from the liver | hepatic ducts (right, left, common), cystic duct (storage), gall bladder, common bile duct, hepatopancreatic ampulla (of Vater), duodenum (@ major duodenal papilla) |
| What surrounds the hepatopancreatic ampulla? | The hepatopancreatic sphincter (of Oddi) |
| What are the regions of the stomach? | cardia, fundus, body, pyloric (+ pyloric sphincter) |
| Which part of the small intestine is intraperitoneal? | duodenal cap (1st 2 cm of duodenum) = horizontal, w/mesentery |
| What are the regions of the duodenum? | 1st = duodenal cap (horizontal), 2nd = descending (vertical; receives bile & pancreatic ducts), 3d = horizontal (horizontal), 4th = ascending (vertical; joins jejunum) |
| What are three characters distinguishing the colon? | teniae coli, haustra, omental appendices |
| What does the transverse colon run between? | (horizontal, right to left): between the hepatic/right colic and splenic/left colic flexures |
| Which arteries supply the foregut, midgut, and hindgut of the embryo? | foregut = celiac trunk, midgut = superior mesenteric artery, hindgut = inferior mesenteric artery |
| What are the branches of the celiac trunk? | 1. left gastric artery, 2. common hepatic artery, 3. splenic artery |
| What are the branches of the superior mesenteric artery? | 1. inferior pancreaticoduodenal, 2. intestinal, 3. ileocolic, 4. right colic, 5. middle colic |
| What are the branches of the inferior mesenteric artery? | 1. left colic, 2. sigmoid, 3. superior rectal |
| Which artery provides anastamosis between the superior and inferior mesenteric arteries? | Marginal artery (of Drummond) = Juxtacolic Artery |
| What are the branches of the common hepatic artery? | gastroduodenal, hepatic, right gastric, right hepatic, left hepatic |
| What artery supplies the stomach? | left & right gastric (lesser curvature), gastroduodenal & left gastro-omental/gastroepiploic (greater curvature), short gastrics (fundus) |
| Which artery supplies the gall bladder? | right hepatic |
| Which artery supplies the duodenum? | inferior pancreaticoduodenal |
| Which artery supplies the pancreas? | gastroduodenal/pancreaticoduodenal & inferior pancreaticoduodenal (head), splenic artery pancreatic branches (body & tail) |
| Which abdominal veins drain into the splenic vein? | splenic & superior mesenteric, forms the portal vein (inferior mesenteric drains into splenic) |
| What are the anastomoses of the portal and systemic venous systems? | 1. gastroesophageal, 2. anorectal, 3. paraumbilical, 4. retroperitoneal |
| What structures are found in the perineal pouch? | 1. Ischiocavernosus, Bulbospongiosus, & Superficial transverse Perineal Muscles. 2. Crura, Bulb of Penis/Vestibular Bulbs, Greater Vestibular Glands (female) |
| What are the boundaries of the perineum? | anterior: the pubic arch and the arcuate ligament of the pubis. Posterior: tip of the coccyx. Lateral: inferior rami of the pubis and ischial tuberosity, and the sacrotuberous ligament |
| What are the boundaries of the femoral triangle? | superiorly = inguinal ligament. medial= adductor longus muscle. lateral = sartorius muscle. floor = adductor longus, pectineus and iliopsoas. roof = fascia lata. |
| What separates skin from the superficial perineal pouch? | Colle's fascia |
| What passes through the aortic hiatus? | aorta, azygos vein, thoracic duct |
| Which veins drain directly into the superior vena cava? | ONLY the azygos vein |
| At what level is the vena caval foramen? | Hole in the diaphragm for ONLY the inferior vena cava, found at T8 |
| At what level is the esophageal hiatus? | Hole in the diaphragm for the esophagus, vagus, & small esophageal arteries, found at T10 |
| What are the nerves of the lumbar plexus? | Iliohypogastric & Ilioinguinal (L1), Genitofemoral (L1-2), Lateral Femoral Cutaneous (L2-3), Nerve to Psoas & Iliacus (L2-4), Femoral (L2-4), Accessory Obturator & Obturator (L2-4), Lumbosacral Trunk (L4-5) |
| Which arteries branch from the internal iliac? | "I Love Going Places In My Very Own Underwear": Iliolumbar, Lateral sacral, Gluteal (Superior & Inferior), Pudendal (internal), Inferior vesical (or uterine), Middle rectal, Vaginal, Obturator, Umbilical |
| What is the source of the ovarian artery? | Descending Aorta |
| Which organ is found on the posterior wall of the lesser sac? | pancreas |
| What type of joint lies between the costal cartilage and the sternum? | synovial!!! |
| Which structures are retriperitoneal? | SAD PUCKER : Suprarenal glands (adrenals), Aorta, Duodenum (2nd-3d parts), Pancreas (except tail), Ureters, Colon (ascending/descending), Kidneys, Esophagus, Rectum |
| Which structure is closest to the pulmonary ligament in the hilum of the right lung? | pulmonary artery |
| Which rib marks the inferior boundary of the right lung at the midaxillary line? | 10! |
| What is the function of the Ligament of Treitz? | extends from the esophageal hiatus and anchors the duodenal-jejunal junction to the posterior wall |
| What structure passes posterior to the liver and is anchored to its posterior side? | Inferior Vena Cava |
| What is McBurney's Point and where is it located? | Located 2/3 from umbilicus to anterior iliac spine, source of pain during appendicitis. |
| What are the branches of the descending aorta? | 1. Inferior Phrenic (2), 2. Celiac Trunk, 3. Inferior & Middle Suprarenal, 4. Superior Mesenteric, 5. Left & Right Renal, 6. Lumbar (4), 7. Testicular/Ovarian (2), 8. Inferior Mesenteric, 9. Common Iliac (2) |
| What is the mnemonic for branches of the descending aorta? | "Prostitutes Cause Sagging Swollen Red Testicles [in men] Living In Sin": Phrenic [inferior], Celiac, Superior mesenteric, Suprarenal [middle], Renal, Testicular [in men; Ovarian in women], Lumbars, Inferior mesenteric, Sacral (median) |
| What passes through the Foramen of Winslow? | Nothing! Connects omental bursa (lesser sac) to greater sac |
| What is the path of the ureters from the kidneys? | superficially across psoas muscles & iliac arteries & veins (deep to the gonadal arteries & veins) |
| What are the layers of the kidney from external to internal? | fibrous capsule, cortex, medulla, renal pyramids & columns, renal pelvis |
| What is the path of fluid through the kidneys? | glomerulus, collecting tubules, renal papillae, minor calyxes, major calyxes, renal pelvis, ureter, urinary bladder |
| Where are the narrow points along the ureters where kidney stones lodge? | 1. where renal pelvis drains into ureter, 2. where ureter crosses common iliac artery, 3. where ureter enters bladder |
| Which veins drein the suprarenal glands? | ONLY the suprarenal vein |
| What are the muscles & innervations of the posterior abdominal wall? | 1. Quadratus lumborum (ventral primary rami T12-L4), 2. Psoas Major (ventral primary rami L1-3), 3. Iliacus (femoral nerve) |
| What action does the psoas major have? | flexes thigh & trunk |
| What action does the Iliacus have? | flexes the thigh (with psoas) |
| What action does the Quadratus Lumborum have? | laterally flexes the trunk, may assist in respiration |
| Which arteries & nerves supply the prostate? | Inferior vesicle artery (from internal iliac), inferior hypogastric nerve plexus (from hypogastric nerve & pelvic & sacral splanchnics) |
| What are the arteries supplying the pancreas? | 1. inferior pancreaticoduodenal (from superior mesenteric, becomes anterior & posterior superior pancreaticoduodenal, then anastamoses with 2. gastroduodenal, 3. splenic (travels through body & tail of pancreas) |
| Which structures form the pelvic brim? | pubic crest, pecten pubis, arcuate line of ilium, anterior border of sacral ala, sacral promontory |
| What separates the true and false pelvis? | Superior pelvic aperture (pelvic inlet). Measured during female pelvic exam. |
| What are the borders of the inferior pelvic aperture (pelvic outlet)? | sacrum & coccyx posterior, pubic symphysis anterior, ischial tuberosities lateral |
| Which structures pass through the greater sciatic foramen? | superior gluteal vessels & nerve, piriformis, inferior gluteal & internal pudendal vessels, inferior gluteal nerve, pudendal nerve, sciatic nerve, posterior femoral cutaneous nerve, Nerve to obturator internus, Nerve to quadratus femoris |
| Which ligaments forms the superior and posterior border of the lesser sciatic foramen? | Superior = sacrospinous ligament, Posterior(inferior)= sacrotuberous ligament |
| which joint transmits body weight from the body to the hip bones? | Sacroiliac joint (synovial, little mobility) |
| Which ligaments prevent upward rotation of the sacrum due to weight of the trunk? | Sacrotuberous & Sacrospinous |
| Which muscles insert onto the greater trochanter of the femur? | obturator internus, piriformis (both cause lateral rotation of the thigh) |
| Which structures pass through the lesser sciatic foramen? | Tendon of the Obturator internus, internal pudendal artery, internal pudendal veins, pudendal nerve * nerve to the obturator internus |
| What is the source & the course of the pudendal nerve? | S2-4 sacral plexus, passes b/tw piriformis & coccygeus, exits the pelvis @ greater sciatic foramen, crosses spine of the ischium, and reenters the pelvis @ lesser sciatic foramen, continues along the lateral ischiorectal fossa in pudendal canal. |
| Which nerves supply the male/female external genitalia? | pudendal nerve (sensory cutaneous + anal & bladder sphincters + bulbospongiosus & ischiocavernosus muscles (orgasm)). genital branch of genitofemoral (to skin & cremaster) & ilioinguinal nerve supply the scrotum/labia. |
| Which arteries supply the female internal genitalia? | ovarian artery (from abdominal aorta), anastamoses with uterine artery (from internal iliac), vaginal artery (internal iliac) |
| What is the source of the median/lateral sacral arteries? and the superior/middle/inferior rectal arteries? | Median sacral from abdominal aorta, Lateral sacral from internal iliac. Superior rectal from inferior mesenteric, middle from internal iliac, inferior from internal pudendal artery |
| Which nerves contribute the sacral plexus? | ventral primary rami L4-S4 (including lumbosacral trunk) |
| What are the nerves of the sacral plexus? | pudendal, sciatic, superior & inferior gluteal |
| What are the actions of the pectineus muscle? | (superior pubic ramus to lesser trochanter) Flexion, Adduction, Medial Rotation of the thigh (served by obturator artery & femoral nerve) |
| What is the location and the action of the gemellus muscles? | superior & inferior, originate @ the spine of the ischium, insert on the obturator tendon. Lateral Rotation of the thigh. |
| What is the path of the left vs. right recurrent laryngeal nerve? | left = under arch of the aorta, right = under right subclavian |
| What is the supply of the sympathetic trunk thoracic ganglia? | 1. efferent white rami communicans from T1-L2 (myelinated preganglionic sympathetic) , 2. afferent gray rami communicans (unmyelinated postganglionic sympathetic fibers) |
| What is the level of the carina? | T5-T6 bodies |
| smooth muscle wall of bladder + internal anatomy | detrusor muscle forms wall, rugae inside except for trigone (uterific orifices & internal urethral orifice mark angles) |
| blood supply to bladder | superior vesical arteries & inferior vesical (male) or vaginal (female) arteries |
| what connects the apex of the bladder to the anterior abdominal wall? | median umbilical ligament (remnant of the embryonic urachus that connected the bladder to the alantois) |
| innervation of the bladder | parasympathetic from pelvic splanchnics + sympathetics + visceral afferents |
| which nerves are responsible for erection and orgasm? | erection = parasympathetic sacral plexus, orgasm = pudendal |
| which sphincter is voluntary and which is involuntary in the bladder? | external voluntary, internal involuntary |
| Which ligament encloses the body of the uterus and what are its components? | Broad Ligament, contains 1. mesovarium (attaches to ovaries), 2. mesosalpinx (contains uterine tube), suspensory ligament (from lateral pelvic wall to ovary, contains ovarian vessels), parametrium (smooth muscle & connective tissue) |
| Which ligament contains the uterine arteries & veins? | Transverse Cervical Ligaments (Cardinal Ligaments), from cervix to lateral wall of pelvis |
| Which ligament connects to the ovary to the uterus? | proper ligament of the ovary |
| What separates the vagina and the rectum? | rectovaginal septum, portion of levator ani forms vaginal sphincter |
| What are the boundaries of the anal triangle? | tip of coccyx, imaginary line joining ischial tuberosities |
| What are Bartholin's glands? | = greater vestibular glands, secrete lubricating mucus into vestibule during sexual arousal |
| Colle's fascia | superficial perineal fascia in pubis, continuous with Scarpa's fascia of abdomen & fascia lata of the thigh |
| What are the contents of the superficial perineal space? | root of clitoris/penis, bulbs of vestibule/penis, bulbospongiosus, ischiocavernosus, superficial transverse perineal muscle, greater vestibular glands, branches of internal pudendal vessels & nerve |
| Which fascia border the deep perineal space? | inferior fascia of the urogenital diaphragm, and inferior fascia of the pelvic diaphragm |
| What is contained in the deep perineal space? | urethra, urogenital diaphragm, inferior part of vagina, branches of internal pudendal vessels & nerve |
| what is the blood supply to the ureters? | inferior vesical (male)/uterine (female) |
| What separates each end of the seminal vesicles from the rectum? | peritoneum of rectovesical pouch (superior), rectovesical septum (inferior) |
| Where are the ejaculatory ducts located? | transmit sperm from the ductus deferens to the prostatic urethra |
| what are the anatomical substructures of the prostate gland? | base = superior (near neck of urinary bladder), apex = inferior (near superior fascia of urogenital diaphragm), posterior surface associated with ampulla of rectum, inferolateral surfaces rest on levator ani |
| what is the widest and most dilatable part of the male urethra? What is the shortest/thinnest/narrowest part ? What is the longest part? | wide maleable = prostatic urethra, short narrow = membranous urethra (ends at the bulb of the penis, begins at apex of the prostate), longest = spongy urethra |
| what are the subanatomical parts of the male urethra? | urethral crest = median longitudinal ridge, prostatic sinus = groove on either side of urethral crest, seminal colliculus = rounded region on urethral crest, prostatic utricle = blind-end sac, openings of ejaculatory ducts |
| Where is the rectosigmoid junction? | anterior to the S3 vertebral body |
| Which anal sphincter is voluntary? | external (internal is involuntary) |
| Which nerves mediate ejaculation? | ejaculation-emission = sympathetics from L1 & 2 (peristalsis of ductus deferens & seminal vesicles), ejaculation-expulsion = sympathetics close internal urethral sphincter & pudendal contracts external urethral sphincter & bulbospongiosus muscles |
| Where are the ejaculatory ducts located? | transmit sperm from the ductus deferens to the prostatic urethra |
| what are the anatomical substructures of the prostate gland? | base = superior (near neck of urinary bladder), apex = inferior (near superior fascia of urogenital diaphragm), posterior surface associated with ampulla of rectum, inferolateral surfaces rest on levator ani |
| what is the widest and most dilatable part of the male urethra? | prostatic urethra (urethral crest = median longitudinal ridge, prostatic sinus = groove on either side of urethral crest, seminal colliculus = rounded region on urethral crest, prostatic utricle = blind-end sac, openings of ejaculatory ducts) |
| Hip medial rotation muscles | gluteus medius, gluteus minimus, tensor fascia latae |
| Biceps femoris origins & insertion | long head origin = tuberosity of the ischium, short head origin = linea aspera, insertion = anterolateral head of the fibula |
| What are the insertions, origins, nerves, & arteries of the femoral adductors? | longus & brevis origin = pubic symphysis, magnus origin = inferior pubic ramus. innervation & vessels = obturator. insertion = posterior femur near linea aspera |
| Supporting body weight on one leg | gluteus minimus & medius, tensor fasciae latae (medial rotators of the thigh. superior gluteal nerve) |
| bladder innervation | detrusor = parasympathetic, visceral afferents (pain) = runs w/sympathetic (upper bladder) or w/parasympathetic (lower bladder)nerves |
| vacular supply to bladder & urethra | superior vesical (branch of umbilical), inferior vesical (male; also prostate & seminal vesicles), vaginal artery (female). Urethra = internal pudendal (peritoneal) |
| which artery do the ureters cross inferior to? | The uterine artery (female; @ level of cervix) / inferior vesical (male) "bridge over water" |
| What are the layers of tissue surrounding the uterus from out to in? | parametrium, myometrium (muscle layer), endometrium (mucosa) |
| Pain fibers for uterus | sympathetic (body of uterus --> 1st stage of labor), maybe parasympathetics (cervix) |
| innervations of the gluteus maximus, medius, & minimus | gluteus maximus (extensor, lateral rotator)= innervated by inferior gluteal, medius & minimus (abductor/medial rotator, keep pelvis level during walking) = superior gluteal nerve (also tensor fascia latae) |
| positive Trendellenburg sign | drag one foot while walking (medius & minimus denervated) |
| sacral plexus | L4-S5 (b/c includes lumbosacral trunk) |
| cutaneous innvervation of the gluteal region | medial/superior = dorsal rami of lumbar & sacral nerves, lateral/superior = lateral femoral cutaneous nerve, inferior = posterior cutaneous nerve of thigh |
| break the hip | neck of the femur (disrupts blood supply from circumflex arteries). If doesn't return -> avascular necrosis requiring hip replacement |
| femoral triangle | sartorius, adductor longus, inguinal ligament (contains femoral nerve/artery/vein/lymphatics [NAVL] from lateral to medial), roof = fascia latae, floor = pectineus & iliopsoas |
| medial circumflex femoral artery (off of profundus femoris) | passes between pectineus & iliopsoas on floor of femoral triangle |
| femoral sheath fascia & contents | artery/vein/lymphatics, NOT NERVE. anterior fascia = from ? , posterior fascia = from ?, femoral ring = , femoral canal = , (femoral hernia -- women have larger femoral ring = more common hernias) |
| adductor canal | begins @ apex of femoral triangle (deep to sartorius), contains femoral vein & artery & saphenous nerve (branch of femoral nerve) |
| adductor hiatus | femoral vessels, but not scaphenous nerve pass through |
| cutaneous innervation of the thigh | genitofemoral innervation of superior anterior thigh, anterior thigh = femoral nerve cutaneous branches, lateral thigh = lateral femoral cutaneous, medial thigh just superior to knee = obturator, posterior = posterior cutaneous nerve of thigh. |
| anterior compartment of the thigh | femoral nerve & artery, profunda femoris artery. pectineus (innervated by obturator also), iliopsoas (lesser trochanter), sartorius, tensor fascia latae, rectus femoris. Quadriceps. |
| medial compartment of the thigh | obturator nerve & artery. adductor longus, brevis & magnus (adductor/pubofemoral portion, inserts on linea aspera), gracilis |
| posterior compartment of the thigh | sciatic nerve: (lateral) common fibular/peroneal division & tibular (medial) division. Perforating arteries (branching from profunda femoris). biceps femoris, semitendinosus, semimembranosus, hamstring/ischiochondilar portion of adductor magnus |
| damage to L5 | ="sciatica". pain down hip sciatic nerve all the way down to foot. |
| blood supply to thigh | femoral artery |
| muscles attached to ischial tuberosity | long head of the biceps femoris, semitendinosus, semimembranosus |
| short head of biceps femoris | innervated by peroneal branch of femoral nerve |
| hamstring muscles | tendons of biceps, semitendonosus & semimembranosus. posterior compartment & cross knee) NOT hamstring portion of the adductor magnus |
| hyperabduction of thigh | -> avulsed adductor longus (torn) |
| adduction of hip joint | pectineus (also flexes) + adductors of thigh |
| hip flexion | iliopsoas (strongest flexor; psoas innervated by ventral rami L1-3, iliacus innervated by femoral nerve) |
| sartorius actions | anterior superior iliac spine to tibia, flexes & laterally rotates hip, flexes knee |
| tensor fascia latae | superior gluteal nerve, flexes/abducts/medially rotates hip |
| rectus femoris | anterior inferior iliac spine to quadriceps tendon (patella). flexes hip. |
| vastus | lateralus/medialus/intermedius, inserts on quadriceps tendon. extends knee. anterior compartment of femoral nerve. |
| muscles of pes anserinus (duck's foot) | sartorius, gracilis, semitendinosus flex knee (order anterior to posterior: Say Grace before T) |
| knee joint | synovial, hinge, uniaxial joint. flexion & extension, some rotation (tibia w/respect to femur). tibio-femoral & patellofemoral. quadriceps tendon increases moment arm of quadriceps around patella) & patellar ligament. |
| jump from great height/lift too heavy a weight | tear quadriceps tendon/patellar ligament = cannot extend knee anymore. |
| chondromalacia patella | grinding of patella against femur because of patella no longer tracking in groove. build up vastus medialis & wear brace to fix. |
| bursitis | suprapatellar (b/tw quadriceps tendon & femur), prepatellar & infrapatellar (over tibial tuberosity where patellar ligament attaches) |
| menisci of the knee | medial meniscus = C shaped, lateral mensicus = ) shaped. protect cartilage of femur & tibia. if removed, cartilage wears away. |
| anterior drawer test | tests integrity of anterior cruciate ligament |
| blow to lateral side of knee | damages tibular collateral ligament & medial meniscus (fused), anterior cruciate ligament (("unhappy triad")) |
| knee flexors | gastrocnemius, popliteus, plantaris, pes anserinus muscles |
| tibia & femur during knee movements | tibia rotates laterally (rotates medially w/knee flexion). femur rotates medially when standing up & laterally when sitting down. femur & tibia get closer when knee extension (locked knee) |
| popliteus action | unlocks the knee when in standing position. inwardly rotates the tibia in order to flex the knee. attached to the lateral meniscus and draws it posteriorly during knee flexion to prevent crushing the meniscus between the tibia/femur as the knee flexes. |
| adductor canal | saphenous nerve does not pass through adductor hiatus. femoral vessels pass through to popliteal fossa (now = popliteal vessels). |
| popliteal fossa boundaries | superolateral biceps femoris, superomedialis = semitendinsosus & membranosus, inferior = inferior & medial heads of gastrocnemius. |
| popliteal fossa contents | common peroneal & tibial division, sural branch of sciatic nerve. small/lesser saphenous vein (drains into popliteal vein). superomedial & lateral, inferomedial & lateral geniculate arteries (anastamoses). |
| Which muscle goes through the greater/lesser sciatic foramen? | piriformis = sacrum -> greater notch -> ischial spine. obturator internus = covers obturator foramen (forms obturator canal) & inferior ramus of pelvis -> lesser notch -> medial greater trochanter |
| which artery runs superior to the piriformis and exits the pelvis under the coccygeus, running through the greater sciatic foramen? | internal pudendal artery |
| what are the borders of the perineum? | coccygeus to left & right ischial tuberosities to pubic symphysis. anterior triangle = urogenital triangle. posterior triangle = anal triangle. |
| relationship of rectum & peritoneum | superior rectum covered on 3 sides by peritoneum = intraperitoneal, middle third of rectum covered only on anterior side by peritoneum = retroperitoneal, inferior third = underneath peritoneum = subperitoneal. after levator ani = anal canal in perineum |
| blood supply to rectum | superior rectal = from inferior mesenteric. middle rectal = from internal iliac (usually from internal pudendal). inferior rectal (also goes to anal canal) = from internal pudendal in ischiorectal fossa |
| borders of ischioanal fossa | lateral = obturator internus, roof = levator ani, medially = external anal sphincter. contents = internal pudendal & inferior rectal neurovascular bundles |
| what structure forms the pudendal canal and what passes through it? | formed by the obturator internus fascia, carries the internal pudendal vessels & the pudendal nerve |
| innervation of muscles around anus | inferior rectal nerve (from pudendal S2-4) = voluntary sphincter. S2-4 pelvic splanchnics = parasympathetics, + sympathetics from superior hypogastric plexus = pelvic plexus/inferior hypogastric plexus = control involuntary internal sphincter. |
| semen pathway | sperm 2-5% =lobes of testes -> seminiferous tubules -> efferent ductules -> epidydimus -> ductus deferens -> dilated ampulla (post. inf. of bladder), crosses anterior to ureters -> + seminal vesicles 70% = ejaculatory duct @ prostate 20% |
| artery of ductus deferens source | branch of superior vesical artery from umbilical artery |
| openings of ejaculatory ducts into prostate | seminal colliculus |
| homologue of vagina & uterus in the male | prostatic utricle |
| urogenital diaphragm | inferior fascia of UG diaphragm = perineal membrane (borders deep perineal pouch)/muscle/superior fascia of UG diaphragm, inf. to levator ani, Bulbourethral gland, membranous urethra |
| contents of deep perineal pouch | deep transverse perineal muscle, membranous urethra, sphincter urethrae muscle (innervated by perineal nerve, branch of pudendal) |
| Bulbourethral Gland | 1% of semen, secretes prior to ejaculation, lubrication + alkalination, enters @ spongy urethra |
| straddle injury (in male) | ruptured urethra. extravasation moves into perineum in UG triangle only, & into scrotum & into shaft of penis & anterior abdominal wall. NOT in thigh. Colle's fascia (directly continuous w/Scarpa's fascia). |
| Colle's fascia (= superficial fascia of perineum) | attached to ischiopubic rami, fused w/posterior part of perineal membrane, fused w/fascia latae @ level of inguinal ligament, continuous w/dartos fascia in scrotum & penus, continuous w/Scarpa's fascia. |
| contents of superficial perineal pouch | Ischiocavernosus, Bulbospongiosus, Superficial transverse perineal muscle, Crura of penis (male)/ crura of clitoris (female), Bulb of penis (male)/vestibular bulbs (female), Greater vestibular glands (female) |
| crura of penis covered by...bulb of penis covered by | ischiocavernosus muscle/bulbospongiosus muscle. fused @ median raphe. |
| fascia of the penis | Tunica albuginea = capsule of corpus spongiosum & cavernosum, Buck's fascia holds 3 colums together (attached to suspensory ligament of the penis) |
| ruptured urethra & tunica albuginea but not Buck's fascia | extravasation only around shaft of penis (Buck's = not continuous w/Dartos) |
| source of dorsal nerve of the penis (sensory), artery & vein of penis | branch of pudendal nerve/internal pudendal vein/artery |
| perineal branch of the pudendal nerve innervates which muscles? | 3 muscles in superficial perineal pouch, sphincter urethrae & deep transverse perineal |
| erection & ejaculation | superior hypogastric plexus sympathetics = ejaculation. secretomotor FX, close ureter, vasoconstriction), parasympathetics from pelvic splanchnics S2-4 =erection. arteries dilate & compress veins, prostate & seminal vesicles secretion) = pelvic plexus |
| penis fracture | rupture of tunica albuginea due to direct trauma. detumescence, swelling, echimosis. Buck's fascia intact. (can alternatively tear urethra) |
| innervation of muscles in posterior compartment of the thigh | semitendinosus (tibial), semimembranosus (tibial), biceps femoris long head (tibial) & short head (common peroneal), adductor magnus ischiocondylar/hamstring portion (tibial) |
| innervation of muscles in the medial compartment of the thigh | obturator nerve (gracilis, adductor longus, adductor brevis, adductor magnus pubofemoral portion) |
| innervation of muscles in anterior compartment of the thigh | iliopsoas (iliacus by femoral nerve, psoas major by ventral rami of L1-3), pectineus (femoral & obturator), sartorius (femoral), quadriceps (femoral: rectus femoris, vastus lateralis/intermedius/medialis) |
| thigh abductors | gluteus medius & minimus, tensor fasciae latae (superior gluteal nerve) |
| thigh adductors | adductors brevis/longus/magnus pubofemoral portion, gracilis, pectineus (obturator nerve + femoral (pectineus)) |
| thigh lateral rotators | gluteus maximus, sartorius, piriformis, gemelli, obturator internus & externus, quadratus femoris |
| knee collateral ligaments | tibial (b/tw medial tibial condyle & medial femoral epicondyle. FUSED w/medial meniscus). Fibular collateral (lateral femoral epicondyle & head of fibula; NOT fused w/lateral meniscus) |
| menisci of the knee | medial = C-shaped, most frequently injured. Lateral = O-shaped, loosely attached to tibia. |
| knee flexion | sartorius, gracilis, hamstrings, gastrocnemius, plantaris, popliteus |
| knee extension | quadriceps |
| rotation during knee flexion/extension | when seated, tibia rotates medially for knee extension. when standing up, femur rotates laterally. |
| lateral rotator of the knee | biceps femoris |
| medial rotator of the knee | semitendinosus, semimembranosus, popliteus (unlocks knee) |
| deltoid ligament | several compound ligaments running from medial malleolus to tarsal bones |
| which ligaments of the foot attach at the fibula | anterior & posterior talofibular, tibiofibular, calcaneofibular ligaments |
| which ligaments resist inversion & eversion? | talifibular/calcaneofibular resist inversion. deltoid ligament resists eversion |
| order of muscles in the anterior leg (medial to lateral) | tibialis anterior (against tibia), extensor hallicus longus, etensor digitorum longus, peroneus tertius (deep peroneal nerve) |
| order of muscles in the lateral compartment of the leg | peroneus longus & brevis (superficial peroneal nerve) |
| order of muscles in the posterior compartment of the leg | superficial: gastrocnemius, soleus, plantaris. deep: popliteus, flexor hallicis longus, tibialis posterior, flexor digitorum longus |
| Which artery becomes the dorsus pedalis at the malleolus? | anterior tibial |
| which artery runs posterior to the medial malleolus toward the plantar foot & becomes the plantar arteries? | posterior tibial artery |
| which nerves supply cutaneous sensation of the leg? | medial 2/3 anterior & medial 1/3 posterior= saphenous. lateral 1/3 ant. & lateral 2/3 posterior = sural. superficial peroneal innervates some distal lateral skin. |
| plantarflexors | all posterior, medial & lateral leg muscles |
| dorsiflexors | (anterior compartment) tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius |
| foot invertors | extensor hallucis longus, tibialis anterior, flexor digitorum longus, tibialis posterior, flexor hallucis longus [HT-DTH] |
| foot evertors | peroneus longus & brevis & tertius, extensor digitorum longus |
| components of the medial longitudinal arch of the foot | calcaneous, talus (keystone), navicular, cuneiforms, medial 3 metatarsals. spring ligament connects (plantar calcaneonavicular ligament) + tendon of tibialis posterior (only when contracting) |
| components of the lateral longitudinal arch of the foot | calcaneus, cuboid (keystone), lateral 2 metatarsals. supported by long and short plantar ligaments + tendon of peroneus longus (when contracting) + sustentaculum tali + plantar calcaneonavicular (spring) ligament. |
| components of the transverse arch of the foot | navicular, cuneiforms, cuboid, metatarsals. both feet together forms the complete arch. |
| what runs deep to the flexor retinaculum of the foot? | (runs b/tw medial malleolus & medial surface of calcaneus) tibial nerve, posterior tibial vessels, tibialis posterior, flexor digitorum longus, flexor hallucis longus (posterior to medial malleolus). |
| what runs deep to the extensor retinaculum of the foot? | (runs from tibia to calcaneus, laterally) deep peroneal nerve, anterior tibial artery, tendons of anterior compartment of leg |
| extensor brevis muscles | extensor digitorum brevis (toes 2-4), extensor hallucis brevis (hallux). Deep Peroneal Nerve innervates. origin = anterior calcaneus. |
| 1st layer of plantar surface muscles of the foot | abductor hallucis, abductor digiti minimi, flexor digitorum brevis (toes 2-4 64% of time) |
| 2nd layer of plantar muscles of the foot | quadratus plantae (insertion = tendon of flexor digitorum longus), lumbricals (origin = tendons of flexor digitorum longus) |
| action of the quadratus plantae & lumbricals | quadratus plantae redirects action of flexor digitorum longus so that toes flex straight down. lumbricals flex metatarsophalangeal joints & extend interphalangeal joints of toes 2-4. |
| 3d layer of plantar muscles of the foot | flexor hallucis brevis, flexor digiti minimi, adductor hallucis |
| 4th layer of plantar muscles of the foot | interossei (abduct & adduct digits w/respect to digit 2). 3 plantar & 4 dorsal interossei. |
| foot muscles innervated by the medial plantar nerve | LAFF: Lumbrical #1, Abductor Hallucis, Flexor Hallucis Brevis, Flexor Digitorum Brevis. |
| plantar arch | anastamosis of lateral plantar artery (from posterior tibial) & dorsalis pedis artery (from anterior tibial) |
| veinous drainage of the foot | medial drains to great saphenous vein. lateral drains to lesser/small saphenous vein. |
| cutaneous innervation of the foot | Dorsal = deep peroneal nerve (crease b/tw toes 1 & 2) + superficial peroneal nerve. Plantar = sural (heel) + medial & lateral plantar nerves (division bt/w 3d & 4th toe). |
| toe flexion | flexor digitorum longus & brevis, flexor hallucis longus & brevis, flexor digiti minimi, lumbricals (@ metatarsophalangeal joint). |
| toe extension | extensor digitorum longus & brevis, extensor hallucis longus & brevis, lumbricals (@ interphalangeal joint). |
| Toe abduction | dorsal interossei, abductor hallucis, abductor digiti minimi |
| Toe adduction | plantar interossei, adductor hallucis |
| injury to the superficial peroneal nerve | inability to evert the foot + loss of cutaneous sensation of dorsum of the foot (except crease between toes 1 & 2) |
| fallen arches | cause = disintegration of tibialis posterior tendon. fix = suture tendons of flexor digitorum longus & flexor hallicis longus. Cut flexor hallicis longus tendon proximally & suture to tibialis posterior & to insertion point of tibialis posterior. |
| innervation of the extensor hallicus brevis & extensor digitorum brevis (digits 2-4) | deep peroneal nerve (does not innervate dorsal interossei) |
| innervation of all foot interossei | lateral plantar nerve |
| where does the dorsalis pedis artery dive | between the 1st & 2nd metatarsals |
| which arteries pass through the adductor magnus? | perforating arteries of the profunda femoris |
| which artery feeds, but does not enter the lateral compartment of the leg? | peroneal artery |
| most powerful flexor of hip joint | iliopsoas (femoral nerve - iliacus, + L1-3 Lumbar plexus - psoas) |
| innervation of the popliteus & plantaris | tibial nerve |
| which quadriceps muscle flexes the hip? | rectus femoris |
| posterior muscles that extend hip joint | gluteus maximus, hamstrings (except short head of the biceps femoris) |
| innervation of the long head of the biceps femoris vs. the short head | tibial division of sciatic nerve. short head = common peroneal nerve |
| over-eversion of the foot damages what? | deltoid ligament |
| gluteus maximus function | laterally rotate hip and extends the hip |
| gemellus function | lateral rotators of hip (superior = nerve to obturator internus, inferior = nerve to quadratus femoris, both from sacral plexus) |
| which tendon passes inferior to the collateral ligament of the fibula? | popliteus tendon runs deep to LCL and passes thru a hiatus in the coronary ligament to attach to the femur |
| gluteus medius & minimus function | With a straight leg, they abduct the thigh. For walking, they & the tensor fascia latae prevent the pelvis from dropping to the opposite side. With the hip flexed they laterally rotate the thigh. With the hip extended, they medially rotate the thigh. |
| injury to the common peroneal nerve | Damage to this nerve typically results in foot drop, where dorsiflexion of the foot is compromised and the foot drags (the toe points) during walking; and in sensory loss to the dorsal surface of the foot and portions of the anterior, lower-lateral leg. |
| quadratus lumborum innervation | T12-L4 (extends the back) |
| Cremaster Reflex | ilioinguinal L1 sends message to genitofemoral to contract cremaster |
| injury to lumbar vertebrae | L1-2 psoas major, L2 iliacus, L2-3 Sartorius, |
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