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The Structural Basis of Medical Practice (SBMP) - Human Gross Anatomy, Radiology, and Embryology

Answer Guide for Lower Limb and Thorax Essay Examination (36 pts) - September 05, 2003

The College of Medicine at The Pennsylvania State University

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[ Heart Valves and Coronary Flow ] [ Flexion and Extension of the Toes ] [ Femoral Triangle ]

Note. The following is a guide to answering the questions and is not the "answer."

  1. Discuss the structure and function (including blood flow to the coronary vessels) of the semilunar valves and the atrioventricular valves (12 pts)

  2. Discuss the muscles and ligaments involved with flexion and extension of the digits of the foot, and relate this to function

  3. Review the boundaries (6 in number) and contents (vasculature, nerves, lymphatics) of the femoral triangle.  State the relationship of structures entering and leaving this region. (12 pts)

    1. superior boundary: Inguinal ligament spanning the anterior superior iliac spine and pubic tubercle (including a figure would help)
      • contents of  the muscular and vascular lacunae enter the femoral triangle (discuss relations)
      • Vascular lacuna.
        • The vascular lacuna is located posterior to the inguinal ligament, medial to the iliopectineal arch, lateral to the lacunar ligament, and anterior to the pectineal fascia.
        • The contents include, from the lateral to medial, the femoral artery, the femoral vein, and the femoral canal.
        • These contents are contained within compartments of the femoral sheath.  These compartments are separated by septa that run between the inguinal ligament and the pectineal fascia.
        • Femoral hernias occur in this region.
        • abdominal viscera may enter the femoral canal through the femoral ring.
      • Muscular lacuna
        • posterior to inguinal ligament and lateral to iliopectineal arch
        • femoral nerve enters femoral triangle deep to iliacus fascia
        • lateral femoral cutaneous nerve enters femoral triangle lateral to femoral nerve and near anterior superior iliac spine
    2. lateral boundary: sartious
      • lateral femoral circumflex a/v exits laterally deep to sartious and between rectus femoris and vasti
    3. medial boundary: adductor longus
      • profunda femoral a/v exits posteromedial deep to super border of adductor longus and continues between adductor longus and adductor magnus
    4. inferior boundary: adductor canal at the apex
      • Adductor canal.
        • At the apex of the femoral triangle is the beginning of the adductor canal.
        • The femoral artery and vein, and the saphenous nerve enter the adductor canal.
          • artery anterior to vein - note: this relation betrays relation of popliteal vessels
        • The adductor canal is bounded anteromedially by the sartorius muscle. Anterolaterally, it is bounded by the vastus medialis.  Posteriorly it is bounded by adductor longus and adductor magnus.
        • nerve to vastus intermedius enters adductor canal
    5. posterior boundary: iliopsoas, pectineus, and possibly parts of adductor brevis and adductor longus
      • the medial femoral circumflex a/v exits between iliopsoas and pectineus
      • the deep femoral artery exits between iliopsoas and adductor longus
    6. anterior boundary: fascia lata and saphenous hiatus (show relations fig)
      • the contents of the cribriform fascia exit the femoral triangle at this location
      • superficial/external pudendal a/v
      • superficial epigastric a/v
      • superficial circumflex iliac a/v
      • the great saphenous vein
      • anterior femoral cutaneous nn pierce fascia lata anterior.
    7. further discussion
      • The saphenous hiatus
        • is a specialization of the fascia lata located in the anteromedial thigh just inferior to the inguinal ligament and superficial to the femoral sheath.  The lateral margin overlies the femoral artery.  The medial aspect overlies the femoral canal.  Superiorly is the inguinal ligament.  Approximately 2cm inferior to the inguinal ligament is the inferior cornu over which the great saphenous vein forms an arch as it leaves superficial fascia and enters the femoral vein.  Notable tributaries of the great saphenous vein within the saphenous hiatus are the external pudendal vein coursing medially, the superficial epigastric vein coursing superiorly, and the superficial circumflex iliac vein coursing laterally and superiorly.  Accompanying these veins are branches of the femoral artery.  These vessels are piercing through the surrounding cribriform fascia.  The distinct lateral margin of the saphenous hiatus is the falciform edge.  There are superior and inferior borders referred to as the superior and inferior cornu.  Medially, the hiatus is indistinct and blends with the pectineus fascia.  The femoral ring is located immediately deep to the medial aspect of the saphenous hiatus.  A femoral hernia, if present, can be palpated at this location.  Additionally, a femoral pulse can be located and, thus, easy surgical access to a major artery or vein is possible.
      • Femoral canal
        • Lymph funnel shaped lymph channel located in the most medial compartment of the femoral sheath.
        • Femoral ring is at the superior opening of this canal.
        • Formed by an 1.5cm extension of transversalis fascia from the abdominal cavity into the thigh.
        • Exposed to superficial fascia by the saphenous hiatus.
        • Site of femoral hernia
        • more common in females because of wider pelvic bones and larger femoral ring.

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