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59 Cards in this Set

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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?
the superficial epigastric vein
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).
the great saphenous vein
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) .
great saphenous vein
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.
reversed
Unexplained enlargement of the superficial inguinal lymph nodes (lymphadenopathy) is an indication to do what?
examine the
entire field of drainage for possible cancer or infection.
(testicular/scrotal) cancer in males, but not (testicular/scrotal) cancer, characteristically metastasizes to the superficial inguinal nodes
scrotal cancer not testicular cancer
Uterine cancer in females occasionally metastasizes along the____________________ to the labium majus to reach the superficial inguinal nodes.
round ligament of the uterus
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.
inguinal ligament
The _____________________ gives attachment to the gluteus maximus and tensor fasciae latae muscles.
iliotibial tract
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?
iliotibial band syndrome
The powerful contractions of what muscle may avulse the lesser trochanter in skeletally immature individuals and those with metastatic lesions at
the site?
iliopsoas
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).
psoas abscess
The psoas abscess passes deep to the inguinal ligament and into the proximal thigh, where it may be mistaken for what (3 things)?
a femoral hernia
saphenous varix
enlarged superficial inguinal lymph nodes
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?
a positive iliopsoas maneuver or psoas sign
What muscle may avulse
the ASIS in skeletally immature individuals?
sartorius
Following paralysis of the iliopsoas muscle, the tensor fasciae latae may hypertrophy in a largely
futile effort to help ________________________.
compensate for weakened hip flexion
What muscle may avulse the AIIS in immature athletes?
rectus femoris
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.
femoral nerve
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.
medial femoral circumflex artery
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?
common in postmenopausal women with osteoporosis
Both femoral circumflex arteries also participate with the inferior gluteal and first perforating arteries in what?
cruciate anastomosis
A femoral pulse is easily taken in a supine patient just inferior to the inguinal ligament, midway between the _____ and ______________.
between the ASIS and pubic tubercle
The femoral artery may be compressed
posteriorly against the ____________ and ___________ through the overlying iliopsoas muscle to control bleeding from the lower extremity.
superior pubic ramus and femoral head
Femoral or popliteal laceration may cause rapid exsanguination. If both the femoral artery and vein are lacerated, what may form?
an arteriovenous shunt
The _________ artery is readily accessible for cannulation for cardiac angiography, for arterial blood sampling, and continuous blood pressure monitoring
femoral artery
What vein may be cannulated to access the right side of the heart or to administer
intravenous fluids?
the femoral vein
The hip joint may be seeded with infection that may destroy the joint (septic arthritis) during _________________due to poor technique.
femoral venipuncture
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.
pulmonary thromboemboli
In a femoral hernia, which is more common in females, a loop of intestine or other viscera protrudes through the_________from the abdominal cavity.
femoral ring
The femoral hernia is covered by peritoneum and extraperitoneal connective tissue and may escape through the __________ into superficial fascia of the thigh.
saphenous opening
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.
inferior and lateral to pubic tubercle
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.
lacunar ligament
Because the __________ bursa is continuous with the synovial joint cavity, infection in either space easily spreads to the other.
suprapatellar bursa
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.
synovitis of the knee joint
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?
injury to the medial meniscus
The ___________________ is often injured together with the tibial collateral ligament and medial meniscus as part of the unhappy triad of athletic knee injuries.
anterior cruciate ligament
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.
ligament sprains

tibial collateral ligament
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.
fibular collateral ligament
The _________________ nerve may be injured during a severe varus stress and should be examined along with the fibular collateral ligament.
common fibular nerve
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?
knee valgus with external tibial rotation
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?
anterior drawer sign
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
posterior drawer sign)
Meniscal tears usually involve the medial meniscus rather than the more mobile lateral meniscus. Injury commonly involves _________________ or___________________ during weight-bearing.
flexion-rotation or extension rotation
Symptoms of meniscal tears include ____________, ___________, or__________________.
Effusion or hemarthrosis may be present.
joint line pain, popping, catching, and locking
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?
peripheral third



osteoarthritis
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.
extensor
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?
inability to extend the knee, with a gap developing in the suprapatellar region during the attempt
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 _____________.
tibial tuberosity
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?
quadriceps femoris muscle

upward

Active extension is lost and the defect in the bone may be palpable.
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.
quadriceps femoris
Fractures of the patella must be differentiated from normal variations in patellar structure resulting from ___________________ (e.g., bipartite patella).
lack of fusion of secondary ossification centers
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.
femur
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).
lateral
Other factors that predispose to lateral subluxation include a shorter anterior projection of the lateral femoral condyle and a weak ___________________.
vastus medialis obliquus
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.
positive
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?
prepatellar bursitis or “housemaid’s knee”
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?
a tibial collateral ligament injury
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).
Baker’s (popliteal) cyst
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?
thrombophlebitis