Gluteal Region and Hip — MCQs
Trendelenberg sign is positive in paralysis of all except:
Which of the following statements about the Levator Ani is false?
Subpubic angle in females is
A patient complains to a physician of chronic pain and tingling of the buttocks. The pain is exacerbated when the buttocks are compressed by sitting on a toilet seat or chair for long periods. No lumbar pain is noted. Pain is elicited when the physician performs Freiberg's maneuver. Most likely diagnosis?
"Trendelenburg sign" is positive in damage of the following nerve:
Which of the following statements about the gluteus maximus is incorrect?
Which of the following structures does not pass through the greater sciatic foramen?
Which of the following is an anterior branch of the internal iliac artery?
A 33-year-old male presents with complaints of pain in the left hip. On examination, there is flexion and external rotation of the left lower limb, with a 7 cm shortening of the left lower limb. A gluteal mass is palpable, which moves with the movement of the femoral shaft. What is the most probable diagnosis?
All are predisposing factors of Deep Vein thrombosis, EXCEPT :
Gluteal Region and Hip Indian Medical PG Practice Questions and MCQs
Question 1: Trendelenberg sign is positive in paralysis of all except:
- A. Tensor fascia lata
- B. Gluteus medius
- C. Gluteus minimus
- D. Gluteus maximus (Correct Answer)
Explanation: ***Gluteus maximus*** - The **gluteus maximus** is primarily responsible for **hip extension** and **external rotation**, and its paralysis would lead to a different gait pattern (e.g., gluteus maximus lurch) but not a positive Trendelenburg sign. - The **Trendelenburg sign** specifically assesses the strength and function of the **hip abductors**, which are not the primary role of the gluteus maximus. *Tensor fascia lata* - The **tensor fascia lata** is a hip abductor and internal rotator, contributing to the stability of the pelvis during gait. - Paralysis of the **tensor fascia lata** would weaken hip abduction, contributing to a positive Trendelenburg sign. *Gluteus medius* - The **gluteus medius** is a primary **hip abductor** and is crucial for stabilizing the pelvis when standing on one leg. - Weakness or paralysis of the **gluteus medius** directly leads to a positive Trendelenburg sign, where the unsupported side of the pelvis drops. *Gluteus minimus* - The **gluteus minimus** is also a primary **hip abductor** and works synergistically with the gluteus medius to maintain pelvic stability during gait. - Paralysis of the **gluteus minimus** would impair hip abduction strength, resulting in a positive Trendelenburg sign.
Question 2: Which of the following statements about the Levator Ani is false?
- A. Converges downwards & medially
- B. Attached to the pelvic brim. (Correct Answer)
- C. Made up of iliococcygeus, pubococcygeus, and puborectalis.
- D. Supports pelvic viscera.
Explanation: Attached to the pelvic brim - This statement is **false** because the levator ani does not attach to the pelvic brim (the inlet of the true pelvis). - The levator ani originates from: the **posterior surface of the body of pubis**, the **tendinous arch of obturator fascia** (thickening of obturator fascia on lateral pelvic wall), and the **ischial spine**. - All these attachments are on the **lateral pelvic wall below the pelvic brim**, not at the pelvic brim itself. - The muscles insert into the **perineal body**, **anococcygeal ligament**, and walls of pelvic viscera. *Converges downwards & medially* - This statement is **true** - the levator ani muscles arise from lateral attachments on the pelvic sidewalls and converge **medially and downward** toward the midline. - This creates the characteristic **funnel-shaped pelvic diaphragm** that narrows inferiorly. - The fibers run inferomedially to form a muscular sling supporting pelvic structures. *Supports pelvic viscera* - This is the **primary function** of the levator ani muscle group [1]. - It forms a muscular floor that supports the **bladder, uterus/prostate, and rectum**, preventing prolapse. - The muscle maintains the position of pelvic organs against intra-abdominal pressure. *Made up of iliococcygeus, pubococcygeus, and puborectalis* - This statement is **correct** - the levator ani consists of three main components [1]: - **Puborectalis** - forms a sling around the anorectal junction, important for fecal continence [1]. - **Pubococcygeus** - middle portion, supports pelvic viscera [1]. - **Iliococcygeus** - most posterior portion, extends from ischial spine to coccyx [1].
Question 3: Subpubic angle in females is
- A. 120 degrees
- B. 180 degrees
- C. 70 degrees
- D. 90 degrees (Correct Answer)
Explanation: ***90 degrees*** - The **subpubic angle** in females typically ranges from **80-90 degrees**, making **90 degrees** the most accurate answer among the given options. - This wider angle is a distinguishing feature of the **female pelvis**, reflecting adaptations for childbirth and is significantly wider than the male angle (50-60 degrees). - Standard anatomy references cite the female subpubic angle as approximately **90 degrees** at the upper limit of normal. *120 degrees* - While the female pelvis has a wider angle than males, **120 degrees** exceeds the normal anatomical range. - This value is an overestimation and not representative of the typical female subpubic angle. *180 degrees* - A subpubic angle of **180 degrees** would imply a completely flat, straight line between the pubic rami, which is anatomically impossible. - This value does not represent any normal anatomical configuration in the human pelvis. *70 degrees* - An angle of **70 degrees** is characteristic of the **male subpubic angle**, which is narrower (typically 50-60 degrees, but can be up to 70 degrees). - This narrower angle is not conducive to childbirth and distinguishes the male from the female pelvis.
Question 4: A patient complains to a physician of chronic pain and tingling of the buttocks. The pain is exacerbated when the buttocks are compressed by sitting on a toilet seat or chair for long periods. No lumbar pain is noted. Pain is elicited when the physician performs Freiberg's maneuver. Most likely diagnosis?
- A. Disk compression of the sciatic nerve
- B. Fibromyalgia
- C. Popliteus tendinitis
- D. Piriformis syndrome (Correct Answer)
Explanation: ***Piriformis syndrome*** - The symptoms of **chronic pain and tingling in the buttocks**, exacerbated by sitting, and the positive finding on **Freiberg's maneuver** (passive internal rotation of the hip) are hallmark signs. - This condition involves **entrapment or irritation of the sciatic nerve by the piriformis muscle**, which is located deep in the buttock. *Disk compression of the sciatic nerve* - While it can cause similar symptoms, the absence of **lumbar pain** makes a primary disc issue less likely. - **Freiberg's maneuver** is specific to piriformis irritation, not typically for disk compression. *Fibromyalgia* - Fibromyalgia presents with **widespread musculoskeletal pain** and tenderness, not typically localized to the buttocks with specific positional exacerbation. - It does not involve nerve entrapment or specific orthopedic maneuvers like Freiberg's maneuver. *Popliteus tendinitis* - Popliteus tendinitis causes pain in the **posterolateral aspect of the knee**, not the buttocks. - It is typically associated with activities involving downhill running or pivoting of the knee.
Question 5: "Trendelenburg sign" is positive in damage of the following nerve:
- A. Inferior gluteal nerve
- B. Pudendal nerve
- C. Superior gluteal nerve (Correct Answer)
- D. Posterior tibial nerve
Explanation: ***Superior gluteal nerve*** - Damage to the superior gluteal nerve paralyzes the **gluteus medius** and **minimus** muscles, which are crucial for stabilizing the pelvis during gait. - A positive **Trendelenburg sign** is observed when the unsupported side of the pelvis drops during walking, due to the inability of the hip abductor muscles (innervated by the superior gluteal nerve) to contract effectively. *Inferior gluteal nerve* - The inferior gluteal nerve primarily innervates the **gluteus maximus**, which is responsible for hip extension and external rotation. - Damage to this nerve would primarily affect the ability to climb stairs or stand up from a seated position, but not typically cause a positive Trendelenburg sign. *Pudendal nerve* - The pudendal nerve primarily innervates the **perineum**, external anal sphincter, and external urethral sphincter. - Damage to this nerve causes issues with **urinary** and **fecal incontinence**, or sexual dysfunction, and is not associated with hip stability or the Trendelenburg sign. *Posterior tibial nerve* - The posterior tibial nerve innervates muscles in the posterior compartment of the leg, including the **gastrocnemius**, **soleus**, and muscles in the foot. - Damage to this nerve would affect **plantar flexion** of the foot and inversion, leading to a "foot drop" or gait abnormalities, but not the Trendelenburg sign.
Question 6: Which of the following statements about the gluteus maximus is incorrect?
- A. Supplied by superior gluteal nerve (Correct Answer)
- B. Causes extension at hip
- C. It is lateral rotator of thigh
- D. Insertion is at gluteal tuberosity
Explanation: ***Supplied by superior gluteal nerve*** - The gluteus maximus is primarily innervated by the **inferior gluteal nerve**, not the superior gluteal nerve. - The **superior gluteal nerve** typically supplies the gluteus medius, gluteus minimus, and tensor fasciae latae. *Causes extension at hip* - The gluteus maximus is the **most powerful extensor** of the hip, especially from a flexed position. - This action is crucial for activities such as **climbing stairs**, running, and standing up. *It is lateral rotator of thigh* - The gluteus maximus is a significant **lateral rotator** of the thigh, contributing to external rotation at the hip joint. - Its large size and fiber orientation make it an effective muscle for this action. *Insertion is at gluteal tuberosity* - The gluteus maximus has a dual insertion: a portion inserts onto the **gluteal tuberosity** of the femur. - The majority of its fibers also insert into the **iliotibial tract**, which then attaches to the lateral condyle of the tibia.
Question 7: Which of the following structures does not pass through the greater sciatic foramen?
- A. Piriformis
- B. Superior gluteal nerve
- C. Inferior gluteal nerve
- D. Obturator nerve (Correct Answer)
Explanation: ***Obturator nerve*** - The **obturator nerve** passes through the **obturator foramen** into the medial compartment of the thigh, not the greater sciatic foramen. - Its primary function is to innervate the **adductor muscles** of the thigh and provide sensory innervation to the medial thigh. *Piriformis* - The **piriformis muscle** passes through the **greater sciatic foramen**, dividing it into suprapiriform and infrapiriform spaces. - It runs from the anterior surface of the **sacrum** to the greater trochanter of the femur. *Superior gluteal nerve* - The **superior gluteal nerve** passes through the **suprapiriform part** of the greater sciatic foramen. - It innervates the **gluteus minimus**, **gluteus medius**, and **tensor fasciae latae muscles**. *Inferior gluteal nerve* - The **inferior gluteal nerve** passes through the **infrapiriform part** of the greater sciatic foramen. - It specifically innervates the **gluteus maximus muscle**.
Question 8: Which of the following is an anterior branch of the internal iliac artery?
- A. Superior gluteal artery
- B. Ilio-lumbar artery
- C. Superior vesical artery (Correct Answer)
- D. Inferior gluteal artery
Explanation: ***Superior vesical artery*** - The **superior vesical artery** is typically a **patent remnant of the umbilical artery** and supplies the superior part of the urinary bladder and distal ureter. - It is consistently described as an anterior branch of the internal iliac artery, along with the **umbilical, obturator, inferior vesical, middle rectal, uterine, vaginal, and internal pudendal arteries**. *Superior gluteal artery* - The **superior gluteal artery** is the largest branch of the internal iliac artery, but it consistently arises from the **posterior division**. - It exits the pelvis through the **greater sciatic foramen** superior to the piriformis muscle to supply the gluteal muscles. *Ilio-lumbar artery* - The **ilio-lumbar artery** is a branch of the **posterior division** of the internal iliac artery. - It ascends to supply the **psoas major** and **quadratus lumborum muscles**, and anastomoses with the lumbar and deep circumflex iliac arteries. *Inferior gluteal artery* - The **inferior gluteal artery** is a main artery of the gluteal region, but it typically arises from the **posterior division** of the internal iliac artery, or occasionally from a common trunk with the superior gluteal artery, which also originates posteriorly. - It exits the pelvis through the **greater sciatic foramen**, inferior to the piriformis muscle, to supply the gluteus maximus and adjacent structures.
Question 9: A 33-year-old male presents with complaints of pain in the left hip. On examination, there is flexion and external rotation of the left lower limb, with a 7 cm shortening of the left lower limb. A gluteal mass is palpable, which moves with the movement of the femoral shaft. What is the most probable diagnosis?
- A. Anterior dislocation of hip
- B. Central fracture dislocation
- C. Posterior dislocation
- D. Pipkin's type 4 fracture (Correct Answer)
Explanation: ***Pipkin's type 4 fracture*** - This fracture involves a **femoral head fracture** combined with a **hip dislocation**. The described findings of flexion, external rotation, shortening, and a palpable gluteal mass, which moves with the femoral shaft, are classic signs of a **femoral head fracture-dislocation**, often categorized as a Pipkin type. - The gluteal mass moving with the femoral shaft indicates that the **femoral head** is displaced and can be palpated, which is consistent with a **femoral head fracture** that has dislocated. *Anterior dislocation of hip* - An **anterior hip dislocation** typically presents with the limb in **flexion, abduction, and external rotation**, but it usually involves lengthening rather than shortening due to the head being displaced anteriorly. - There would typically not be a palpable gluteal mass, and the degree of shortening described (7 cm) is more consistent with a complex injury like a fracture-dislocation. *Central fracture dislocation* - A **central fracture dislocation** involves the femoral head pushing through the **acetabulum into the pelvis**. This usually presents with a **shortened and internally rotated limb**, and pain, but not typically a palpable gluteal mass or the specific flexion and external rotation described. - While there is shortening, the mechanism of injury and the palpable mass are not consistent with the femoral head being displaced into the pelvic cavity. *Posterior dislocation* - A **posterior hip dislocation** presents with the limb in **flexion, adduction, and internal rotation**, often with significant shortening. - Although it causes shortening, the patient presents with **external rotation**, not internal rotation, differentiating it from a posterior dislocation. The palpable gluteal mass is also not a typical finding in a pure posterior dislocation without an associated fracture.
Question 10: All are predisposing factors of Deep Vein thrombosis, EXCEPT :
- A. Lower limb trauma
- B. Cushing's syndrome
- C. Hip surgery
- D. Subungual melanoma (Correct Answer)
Explanation: ***Subungual melanoma*** - This is a rare form of melanoma that develops under the nail, and while serious, it is **not a recognized predisposing factor for deep vein thrombosis (DVT)**. Its primary concerns are local invasion and metastasis. - Unlike conditions affecting blood clotting or endothelium, **subungual melanoma does not directly promote hypercoagulability, venous stasis, or endothelial damage** that contribute to DVT. *Lower limb trauma* - **Trauma to the lower limb** can cause **endothelial damage** to blood vessels and **venous stasis** due to immobility or swelling, both key components of **Virchow's triad** for DVT [1]. - **Fractures or severe soft tissue injuries** often necessitate immobilization and can lead to inflammation, further increasing the risk of clot formation [1]. *Cushing's syndrome* - **Cushing's syndrome** is associated with **hypercoagulability** due to increased levels of clotting factors, such as **factor VIII** and **fibrinogen**, and decreased fibrinolytic activity. - The **elevated cortisol levels** seen in Cushing's syndrome [2] can directly contribute to a prothrombotic state, significantly increasing DVT risk. *Hip surgery* - **Major orthopedic surgeries**, especially hip surgery [1], are well-known to cause significant **venous stasis** and **endothelial damage**. - **Post-operative immobility** and a generalized **inflammatory response** following surgery contribute to a high risk of DVT formation [1].
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free