Important viva questions of Articulated skeleton of foot

 Articulated skeleton of foot

1.       Ana points:

·         1^st metatarsal is shortest and thickest and lies medially

·         Tarsal bones are lies posteriorly

·         Phalanges lie anteriorly

·         Superior surface of talus is directed upwards

 

2.       Morphological type : tarsal: short bone metatarsal and phalanges : miniature short bone (why call miniature short bone : because it has one epiphysis)

3.       Parts of metatarsal and phalanges bone : base,  shaft and head

4.       1^st metatarsal and all phalanges : epiphysis present at the base

5.       2^nd to 5^th metatarsal : epiphysis present at the head

6.       Ossification  of Articulated skeleton of foot: intra cartilaginous ossification

7.         Identify tarsal bone

8.       Show attachment of following muscles with origin, action and nerve supply :

 tibialis ant and pos , peroneus longus and brevis, FHL,FDL,tendoachilis- how it is formed 

1.       Show groove for FHL, peroneus longus

2.       Ligament :  deltoid and spring lig : show attachment on bones

1.       Which tarsal bone devoid of muscular attachment: talus  

2.       Joints  of articulated sk of foot–( articular surfaces, type, movement and muscle producing the movement)

Ankle joint	Type: hinge variety of synovial joint Innervation: sural, tibial, saphenous, deep fibular nerves Muscles: tibialis anterior (dorsiflexion), gastrocnemius (plantar flexion)
Inferior (distal) tibial joint	Type : syndesmosis variety of fibrous joint  Muscles: no muscles act on this joint
**Talocalcaneal joint or subtalar joint	Type : plane type of synovial joint Muscles: tibialis anterior, tibialis posterior, gastrocnemius, soleus (inversion); fibularis longus, fibularis tertius, fibularis brevis (eversion)
Talocalcaneonavicular joint	Type: ball and socket type of synovial joint Muscles:  tibialis anterior, tibialis posterior, gastrocnemius, soleus (inversion); fibularis longus, fibularis tertius, fibularis brevis (eversion)
Calcaneocuboid joint	Type : saddle type of synovial joint Muscles: tibialis anterior, tibialis posterior, gastrocnemius, soleus (inversion); fibularis longus, fibularis tertius, fibularis brevis (eversion)
Naviculocuneiform joint	Type : compound joint Muscles: fibularis longus and brevis, tibialis anterior and posterior (gliding, rotation)
Cuboideonavicular joint	Type : syndesmosis variety of fibrous joint Muscles: fibularis longus and brevis, tibialis anterior and posterior (gliding, rotation)
Intercuneiform and cuneocuboid joints	Muscles: Muscles: fibularis longus and brevis, tibialis anterior and posterior (gliding, rotation)
Tarsometatarsal joint	Type : plane variety of synovial joint Muscles: short and long extensors of the toe (flexion, extension);  tibialis anterior, fibularis longus (abduction, rotation)
Intermetatarsal	Plane variety of synovial joint
Metatarsophalangeal	Type : ellipsoid variety of synovial joint Muscles:  flexor digitorum brevis, lumbricales, interossei (flexion);  flexor hallucis longus and brevis (extension);  abductor hallucis, plantar interossei (abduction); adductor hallucis, dorsal interossei, abductor digiti minimi (adduction)
Interphalangeal joints	Type : hinge variety of synovial joint Muscles: flexor digitorum longus and brevis (flexion);  extensor digitorum longus and brevis (extension)

 

3.       Subtalar jt , very important ( muscles producing movement )

4.       Related questions :

5.       What is arch?

6.       How medial and lateral  longitudinal arches are formed ?

7.       How anterior and posterior  transverse arches are formed ?

8.       Factors maintaining the arches of foot

                                              

 

Important viva questions of bony pelvis

 

Bony pelvis

Anatomical points

1.      Anterior superior iliac spine and upper part of pubic symphysis lie in the same coronal  plane

2.      Pubis symphysis lies horizontally

3.      The tip of the coccyx and upper part of pubic symphysis lie in same horizontal plane

|Formation of pelvis : two hip bones, sacrum and coccyx

Joint of pelvis :

Pubic symphysis : secondary cartilaginous joint

Sacroiliac joint : plane variety of synovial joint

Divisions of pelvis : greater(false pelvis )  and lesser pelvis (true )

Why greater pelvis is known as false pelvis: it has no body boundary in front

Why lesser pelvis is known as true pelvis: it has complete body boundary

Q. Trace the pelvic inlet and outlet

Q. Content of pelvis in male and female

Q: How pelvic outlet is covered in living body ?

In front by urogenital diaphragm and behind pelvic diaphragm

Q: What is urogenital diaphragm :

 It is formed by deep transverse perinea muscle and sphincter urethrae muscle

Q: What is pelvic diaphragm

It is formed by levator ani and coccygeus muscle

Show the Diameters of pelvis :

Pelvic inlet

	Antero-posterior diameter	Transverse diameter:	Oblique diameter:
Pelvic inlet	Measured between sacral promontory and symphysis pubis Upper border of pubic symphysis:  True or Anatomical conjugate Middle of pubic symphysis:  Obstetric conjugate (most important) Lower border of pubic symphysis: Diagonal conjugate	Maximum transverse diameter	Measured between the sacro-iliac (SI) joint and opposite ilio-pubic eminence
Pelvic cavity	Middle of S3 vertebra to the middle of the back of pubic symphysis	Widest distance across the lateral bony wall of the pelvic cavity	From the lower end of sacroiliac joint to the center of the opposite obturator membrane
Pelvic outlet	Antero-posterior diameters: From the lower border of symphysis pubis to – Anatomical: tip of coccyx Obstetric: tip of sacrum	Transverse diameters: diameter: between 2 ischial tuberosities	From the junction of the ischiopubic ramus to the middle of the opposite sacrotuberous ligament

 

Diameter of female pelvis

	Antero-posterior diameter	Transverse diameter:	Oblique diameter:
Pelvic inlet	11 cm	13	12
Pelvic cavity	12	12	12
Pelvic outlet	13	11	12

Diameter of different conjugate of  female   :

·         True or Anatomical conjugate: 11 cm

·         Obstetric conjugate (most important): 0.5 cm shorter than the true conjugate

·         Diagonal conjugate: 11.5 cm

Shape of pelvis

1.      Gynecoid (50%) – normal female pelvis

2.      Anthropoid (25%) – direct occipito-posterior position is most common in anthropoid pelvis

3.      Android (20%) – male type (face to pubes delivery, persistent occipito-posterior position, deep transverse arrest/non-rotation, dystocia-dystrophica syndrome are most common in android pelvis)

4.      Platypelloid (5%)

Difference between male and female pelvis

 

Topic	Male	Female
Shape of pelvic inlet	Heart shape	Oval
shape of pelvic caviy	conical and long ( long section of a cone)	short and cylindrical ( short section of a cylinder)
sub pubic angle	less , 55-60 degree	More, about  90 degree
ischial spine	inverted	everted
sacrum	longer and narrower	shorter and wider
Obturator foramen	Larger and oval and abruptly curve	Smaller and triangular, gradually curved

 

 

Summary of cavernous sinus

 

 The cavernous sinuses are placed one on either side of the body of the sphenoid bone, extending from the superior orbital fissure to the apex of the petrous portion of the temporal bone.

 Medial wall (central part) is related to –

1. the internal carotid artery,
2. abducent nerve.

Lateral wall : is related to

1. the oculomotor
2. trochlear nerves,
3. the ophthalmic nerves
4. maxillary divisions of the trigeminal nerve  

The cavernous sinus : tributaries :

1. the superior ophthalmic vein
2. superior and inferior  petrosal sinus
3. pterygoid venous plexus veins
4. The two sinuses also communicate with each other by means of the anterior and posterior intercavernous sinuses.

Flow chart of cranial dura

 

Cranial dural sinus

Cranial dura has two layer : endoesteum layer and meningeal layer

The sinuses of the dura mater are venous channels which drain the blood from the brain;

They are situated between the two layers of the dura mater

They are devoid of valves, and and lined by endothelium but no smooth muscle cells layer.

Different types of dural venous sinus:

1. Pair: cavernous sinus, transverse sinus, sigmoid sinus etc.
2. unpair: superior sagittal sinus, inferior sagittal sinus, straight sinus etc.

Flow chart of cranial dura 

A. Superior sagittal sinus > right transverse sinus > right sigmoid sinus > right internal jugular vein

 B. Inferior sagittal sinus > straight sinus > left transverse sinus > left  sigmoid sinus > left internal jugular vein

Summary of vagus nerve

 Vagus nerve 

Foramen	Type	Functional component	Function	Nuclei
Jugular foramen	Mixed nerve both sensory and motor	SVA:	Carry taste sensation from the posteriormost part of the tongue and epiglottis	Nucleus of tractus solitaries
		GVA	Carry  touch pain temperature sensation from thoracic and abdominal viscera	Nucleus of tractus solitaries
		GSA :	Carry sensation from the skin of the external ear.	Spinal nucleus of trigeminal nerve
		SVE	Muscle of palate, larynx and pharynx	Nucleus ambiguus
		GVE:	Smooth muscle and gland of thoracic and abdominal viscera	Dorsal nucleus of vagus

Summary of glossopharyngeal nerve

 Glossopharyngeal nerve 

Foramen	Type	Parasympathetic ganglion	Functional component	Function	Nuclei
Jugular foramen	Mixed nerve both sensory and motor	This nerve is related with otic ganglion	SVA:	Carry taste sensation from the posterior one-thirds of the tongue	Nucleus of tractus solitaries
			GVA	Carry  touch pain temperature sensation from pharynx and the posterior one-thirds of the tongue	Nucleus of tractus solitaries
			GSA :	Carry sensation from the skin of the external ear.
			SVE	Stylopharyngeus	Nucleus ambiguus
			GVE:	This fibre innervate the parotid gland	Inferior salivary nucleus

 

Essential points of facial nerve

 Essential points of facial nerve 

Facial nerve (VII)

Foramen	Type	Functional component	Function	Nuclei
Internal acoustic meatus , facial canal and stylomastoid foramen	Mixed nerve both sensory and motor	SVA:	Carry taste sensation from the anterior two-thirds of the tongue	Nucleus of tractus solitaries
		GVE:	This fibre innervate the submandibular and sublingual salivary glands, lacrimal gland and gland of nose and palate	Superior salivary nucleus and  lacrimal nuclei
		SVE	This fibre innervate muscles of facial expression, stapedius, the posterior belly of digastric, and the stylohyoid.	Main motor nucleus
		GSA :	Carry sensation from the skin of the external ear.