Peripheral Vascular Diseases and Reflexes

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Questions and Answers

Where can the pulsations of the posterior tibial artery typically be felt?

Midway between the medial malleolus and the heel (correct)

Near the base of the toes

At the anterior knee joint

Just above the ankle joint

Which artery is sometimes absent and replaced by a large perforating branch of the fibular artery?

Dorsalis pedis artery (correct)

Medial plantar artery

Anterior tibial artery

Lateral plantar artery

What type of injuries are associated with meniscal tears in young adults?

Degenerative lesions

Chronic overuse injuries

Acute traumatic injuries (correct)

Inflammatory conditions

Which artery may be larger than normal and can sometimes replace the posterior tibial artery in the lower leg?

Fibular artery Signup and view all the answers

What is the anatomical location of the flexor hallucis longus in relation to the great saphenous vein?

Posterior to the great saphenous vein Signup and view all the answers

What is the condition characterized by pain that disappears with rest but recurs upon walking?

Intermittent Claudication Signup and view all the answers

From which segments of the spinal cord does sympathetic innervation of the arteries to the leg derive?

Lower three thoracic and upper two lumbar segments Signup and view all the answers

What procedure may be used to enhance blood flow in patients with occlusive arterial disease in the lower limb?

Lumbar Sympathectomy Signup and view all the answers

Which nerve provides sympathetic fibers to the femoral artery?

Femoral and Obturator Nerves Signup and view all the answers

What kind of muscle innervation do most skeletal muscles receive?

Multisegmental Innervation from Two to Four Segments Signup and view all the answers

During the patellar tendon reflex, which muscle contracts?

Quadriceps Muscle Signup and view all the answers

Where do preganglionic sympathetic fibers synapse for lower limb innervation?

Lumbar and Sacral Ganglia Signup and view all the answers

What is the role of the Achilles tendon reflex in the context of muscle function?

To evaluate the plantar flexion of the foot Signup and view all the answers

Which of the following muscles is NOT paralyzed due to common fibular nerve injury?

Gastrocnemius Signup and view all the answers

Which area of sensation remains unaffected by common fibular nerve injury?

Medial border of the foot Signup and view all the answers

What type of clinical presentation is often seen in patients with common fibular nerve injuries?

Footdrop Signup and view all the answers

Which two nerves supply the muscles that are paralyzed in a common fibular nerve injury?

Deep fibular nerve and superficial fibular nerve Signup and view all the answers

What is a common cause of injury to the common fibular nerve?

Fractures of the neck of the fibula Signup and view all the answers

Which action is primarily affected by a common fibular nerve injury?

Dorsiflexion Signup and view all the answers

Which nerve is primarily responsible for sensation along the lateral side of the foot?

Sural nerve Signup and view all the answers

What is the primary role of the adductor canal?

Provides passage for femoral vessels and saphenous nerve Signup and view all the answers

Which ligament is most commonly damaged during hyperextension combined with rotation?

Anterior cruciate ligament Signup and view all the answers

What does a positive anterior drawer test indicate?

Tear of the anterior cruciate ligament Signup and view all the answers

Where is the ligamentum patellae attached?

To the tibial tuberosity Signup and view all the answers

What is a common characteristic of meniscal cysts?

They are firm on palpation at the joint line Signup and view all the answers

What distinguishes the posterior cruciate ligament (PCL) from the ACL?

PCL is thicker and stronger than the ACL Signup and view all the answers

What typically causes damage to the PCL?

Direct impact from a dashboard during a car accident Signup and view all the answers

How can the medial and lateral collateral ligaments be identified?

By palpating along the sides of the knee joint line Signup and view all the answers

What type of joint is classified as a synovial ball and socket joint?

Hip joint Signup and view all the answers

Which ligament is known to prevent excessive abduction and extension in the hip joint?

Pubofemoral ligament Signup and view all the answers

What structure is described as the strongest ligament that prevents overextension during standing?

Iliofemoral ligament Signup and view all the answers

Which layer of the foot contains the flexor digitorum longus tendon?

2nd layer Signup and view all the answers

What is the primary composition of the medial collateral ligament in the knee?

Fibrous connective tissue Signup and view all the answers

Which muscle is an abductor of the hallux?

Abductor hallucis Signup and view all the answers

Which part of the body is the tibial plateau associated with?

Tibia Signup and view all the answers

What is the primary function of the plantar aponeurosis?

Support the arch of the foot Signup and view all the answers

What type of cartilage is predominantly found in the knee joint?

Hyaline cartilage Signup and view all the answers

Which ligament connects the femoral head to the acetabulum?

Ligamentum teres Signup and view all the answers

The structure responsible for the suspension from above in the context of foot anatomy refers to which tendon?

Flexor hallucis longus tendon Signup and view all the answers

Which of the following structures is NOT part of the intrinsic muscles of the foot?

Flexor digitorum longus Signup and view all the answers

Which part of the hip joint stabilizes against hyperextension?

Ischiofemoral ligament Signup and view all the answers

Study Notes

Intermittent Claudication

Pain in the legs caused by lack of oxygen during exercise, relieved by rest, and recurring when exercise resumes.

Sympathetic Innervation of Arteries to the Leg

The lower three thoracic and upper two or three lumbar segments of the spinal cord are responsible for supplying the arteries to the leg.
Preganglionic fibers travel through white rami to the lower thoracic and upper lumbar ganglia.
Postganglionic fibers reach blood vessels through branches of the lumbar and sacral plexuses.
The femoral artery receives sympathetic fibers from the femoral and obturator nerves.
More distal arteries receive postganglionic fibers from the common fibular and tibial nerves.

Lumbar Sympathectomy

Treatment option for occlusive arterial disease of the lower limb.
Removal of the upper three lumbar ganglia and the intervening parts of the sympathetic trunk.
Aims to increase blood flow through collateral circulation.

Patellar Tendon Reflex (Knee Jerk)

Extension of the knee joint upon tapping the patellar tendon.
Lumbar segments L2, L3, L4 are involved.
Quadriceps contraction can be felt during the test.

Achilles Tendon Reflex (Ankle Jerk)

S1, S2 segments are involved.

Common Fibular Nerve Injury

The common fibular nerve is vulnerable as it winds around the neck of the fibula.
Can be injured in fractures of the neck of the fibula or by pressure from casts or splints.
Motor: Paralysis of the anterior and lateral leg compartment muscles, leading to footdrop.
Sensory: Loss of sensation on the anterior and lateral leg, dorsum of the foot, and toes.

Anatomy of the Foot

Plantar ligaments: Long & short plantar ligaments, Deep transverse ligament.
Plantar Aponeurosis: Medial part of the plantar aponeurosis.
2nd Layer: Flexor digitorum longus tendon, Flexor hallucis longus tendon, Flexor hallucis brevis, Adductor hallucis.
3rd Layer: aBductor digiti minimi.
1st layer: Quadratus plantae, Lumbricals.
Lateral half of FDL & FDB: Peroneus longus

Hip Joint

Type: Synovial ball and socket.
Composition: Femoral head, acetabulum, hyaline cartilage.
Ligaments: Iliofemoral, pubofemoral, ischiofemoral.

Knee Joint

Type: Hinge joint.
Composition: Femoral condyle, patella, tibial plateau, hyaline cartilage.
Ligaments: Medial Collateral, Lateral Collateral, anterior cruciate (ACL), posterior cruciate (PCL).

Adductor Canal

Located in the middle third of the thigh, distal to the apex of the femoral triangle.
Contains the femoral vessels and the saphenous nerve.

Knee Region

Patella and Ligamentum Patellae: Easily palpated in front of the knee, traced to the tibial tuberosity.
Femoral Condyle and Tibial Condyles: Recognized on the sides of the knee, joint line identifiable between them.
Medial and Lateral Collateral Ligaments: Can be palpated on the sides of the joint line, followed above and below to their bony attachments.

Lateral McMurray's Test

Used for diagnosing meniscal tears, particularly in young adults.
Steps: Leg flexed, foot internally rotated.

Meniscal Injuries

Tears or ruptures often occur during hyperextension movements, especially with rotation.
Degenerative lesions common in middle age.
Symptoms: Joint line tenderness, especially on the lateral side.
Causes: Hyperextension, rotation.

Anterior Cruciate Ligament (ACL)

Damaged more often than the PCL.
Anterior drawer test and Lachman test are diagnostic.

Posterior Cruciate Ligament (PCL)

Thicker and stronger than the ACL.
Damaged by dashboard injuries.
Posterior drawer test is diagnostic.

Posterior Tibial Artery

Lies between the tendons of flexor digitorum longus and flexor hallucis longus.
Pulsations can be palpated midway between the medial malleolus and the heel.

Dorsalis Pedis Artery

May be absent in some individuals, replaced by a large perforating branch of the fibular artery.

Fibular Artery

Can be larger than normal and replace the posterior tibial artery in the lower part of the leg.

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Description

Explore the complex relationship between intermittent claudication, sympathetic innervation of leg arteries, and the patellar tendon reflex. This quiz examines the physiological mechanisms and treatment options for occlusive arterial disease. Test your knowledge on how the nervous system affects blood flow and reflex actions in the lower limbs.