Lower Limb — MCQs

Lower Limb Indian Medical PG Practice Questions and MCQs

Question 291: The superior gluteal nerve supplies all of the following muscles, except?

A. Gluteus medius
B. Gluteus minimus
C. Gluteus maximus (Correct Answer)
D. Tensor fascia lata

Explanation: The **superior gluteal nerve (L4, L5, S1)** is a branch of the sacral plexus that exits the pelvis through the greater sciatic foramen, passing *above* the piriformis muscle. It is responsible for supplying the primary abductors and medial rotators of the hip. **Why Gluteus Maximus is the correct answer:** The **Gluteus maximus** is the exception because it is supplied by the **inferior gluteal nerve (L5, S1, S2)**. This nerve exits the greater sciatic foramen *below* the piriformis. The Gluteus maximus is the chief extensor of the hip, unlike the muscles supplied by the superior gluteal nerve. **Analysis of incorrect options:** * **Gluteus medius & Gluteus minimus:** These are the primary targets of the superior gluteal nerve. They act as the main stabilizers of the pelvis during the stance phase of walking. * **Tensor fascia lata (TFL):** This muscle is also supplied by the superior gluteal nerve. It helps in stabilizing the knee in extension and assists in hip abduction. **High-Yield Clinical Pearls for NEET-PG:** 1. **Trendelenburg Sign:** Injury to the superior gluteal nerve leads to paralysis of the gluteus medius and minimus. When the patient stands on the affected leg, the pelvis drops on the healthy (unsupported) side. 2. **Lurching Gait:** To compensate for the pelvic drop, the patient tilts their trunk toward the affected side while walking (Gluteus medius gait). 3. **Intramuscular Injections:** To avoid injuring the superior gluteal nerve and the sciatic nerve, injections are traditionally given in the **upper outer quadrant** of the gluteal region.

Question 292: What is located most medially in the femoral triangle?

A. Vein
B. Artery
C. Nerve
D. Lymphatics (Correct Answer)

Explanation: The **femoral triangle** is a high-yield anatomical region. To understand the arrangement of its contents, one must distinguish between the triangle itself and the **femoral sheath**. ### 1. Why Lymphatics is Correct The femoral sheath is a fascial funnel divided into three compartments. From **lateral to medial**, the arrangement is: * **Lateral compartment:** Femoral Artery * **Intermediate compartment:** Femoral Vein * **Medial compartment (Femoral Canal):** Contains **lymphatics** (specifically the lymph node of Cloquet/Rosenmüller) [1] and loose areolar tissue. Since the femoral canal is the most medial component of the sheath, the **lymphatics** are the most medial structure within the femoral triangle. A common mnemonic to remember the order from lateral to medial is **NAVY** (Nerve, Artery, Vein, Y-fronts/Lymphatics). ### 2. Why Other Options are Incorrect * **Artery (B) & Vein (A):** The femoral artery lies lateral to the vein. While both are medial to the nerve, they are lateral to the lymphatics. * **Nerve (C):** The **Femoral Nerve** is the most **lateral** structure. Crucially, it lies *outside* the femoral sheath, resting in the groove between the Psoas major and Iliacus muscles. ### 3. Clinical Pearls for NEET-PG * **Femoral Canal:** Its clinical significance lies in **femoral hernias**, which occur through this medial-most compartment [1]. * **Femoral Pulse:** To palpate the femoral artery, feel at the mid-inguinal point (halfway between the ASIS and symphysis pubis). * **Venous Access:** For femoral vein catheterization, the needle is inserted medial to the femoral artery pulse (Mnemonic: **V**ein is **V**ery close to the midline).

Question 293: The Coronary Ligament is present in which joint?

A. Shoulder Joint
B. Hip Joint
C. Knee Joint (Correct Answer)
D. Ankle Joint

Explanation: **Explanation:** The **Coronary Ligaments** (also known as meniscotibial ligaments) are specialized portions of the joint capsule in the **Knee Joint**. They connect the convex peripheral borders of the medial and lateral menisci to the non-articular margins of the tibial condyles. Their primary function is to anchor the menisci to the tibia while allowing them to slide slightly during rotation and flexion-extension movements. **Analysis of Options:** * **Knee Joint (Correct):** The coronary ligaments are essential components of the knee's complex ligamentous apparatus. The medial coronary ligament is generally tighter than the lateral one, which contributes to the medial meniscus being less mobile and more frequently injured. * **Shoulder Joint (Incorrect):** The shoulder is stabilized by the glenohumeral ligaments, coracohumeral ligament, and the glenoid labrum. It does not contain a coronary ligament. * **Hip Joint (Incorrect):** The hip is secured by the iliofemoral (Ligament of Bigelow), pubofemoral, and ischiofemoral ligaments. * **Ankle Joint (Incorrect):** The ankle is supported by the medial (deltoid) ligament and lateral ligaments (anterior/posterior talofibular and calcaneofibular). **High-Yield Clinical Pearls for NEET-PG:** * **Meniscal Mobility:** The lateral meniscus is more mobile than the medial meniscus because its coronary ligament is more lax and it is not attached to the fibular collateral ligament. * **Unhappy Triad (O'Donoghue):** Involves injury to the Anterior Cruciate Ligament (ACL), Medial Collateral Ligament (MCL), and Medial Meniscus. * **Anatomical Note:** Do not confuse these with the *Coronary Ligament of the Liver*, which reflects the peritoneum from the liver to the diaphragm. Always check the context of the question (Anatomy: Lower Limb).

Question 294: Which nerve supplies the muscle shown in the illustration?

A. Superficial peroneal nerve
B. Deep peroneal nerve (Correct Answer)
C. Tibial nerve
D. Sciatic nerve

Explanation: ***Deep peroneal nerve*** - Supplies all muscles in the **anterior compartment** of the leg including **tibialis anterior**, **extensor digitorum longus**, **extensor hallucis longus**, and **peroneus tertius**. - Also innervates **extensor digitorum brevis** in the foot and provides sensation to the **first web space** between the great and second toes. *Superficial peroneal nerve* - Supplies muscles of the **lateral compartment** including **peroneus longus** and **peroneus brevis**, not anterior compartment muscles. - Provides sensory innervation to most of the **dorsum of the foot** except the first web space. *Tibial nerve* - Innervates muscles of the **posterior compartment** of the leg including **gastrocnemius**, **soleus**, and **tibialis posterior**. - Also supplies intrinsic muscles of the foot via **medial and lateral plantar nerves**. *Sciatic nerve* - The **parent nerve** that divides into **tibial** and **common peroneal** (fibular) nerves at the popliteal fossa. - Primarily supplies muscles of the **posterior thigh** before its division, not individual compartments of the leg.

Question 295: Which ligament is located below the head of the talus?

A. Spring ligament (Correct Answer)
B. Deltoid ligament
C. Cervical ligament
D. None of the above

Explanation: **Explanation:** The **Spring ligament**, scientifically known as the **Plantar Calcaneonavicular ligament**, is the correct answer because it forms the floor of the "acetabulum pedis" (the socket for the talar head). It spans the gap between the sustentaculum tali of the calcaneus and the tuberosity of the navicular bone. By lying directly **inferior to the head of the talus**, it plays a critical role in supporting the medial longitudinal arch of the foot and bearing the weight of the body. **Analysis of Incorrect Options:** * **Deltoid Ligament:** This is a strong, triangular ligament located on the **medial aspect** of the ankle joint. While it has a deep component that stabilizes the talus, it is situated medially rather than directly beneath the head. * **Cervical Ligament:** This is a strong band located in the **sinus tarsi** (lateral side). It connects the neck of the talus to the neck of the calcaneus. It is lateral and interosseous, not inferior to the head. **High-Yield Clinical Pearls for NEET-PG:** * **The "Spring" Action:** Despite its name, the ligament contains dense collagen and lacks significant elastic fibers; its "spring" refers to its role in maintaining the arch. * **Flat Foot (Pes Planus):** Chronic stretching or rupture of the spring ligament (often secondary to Tibialis Posterior tendon dysfunction) leads to the collapse of the medial longitudinal arch. * **Keystone of the Arch:** The head of the talus is the "keystone" of the medial longitudinal arch, and the spring ligament is its primary static stabilizer.

Question 296: All of the following structures are contained within the femoral sheath except?

A. Femoral nerve (Correct Answer)
B. Femoral artery
C. Femoral vein
D. Lymphatics

Explanation: ### Explanation The **femoral sheath** is a funnel-shaped fascial sleeve formed by the downward extension of the **fascia transversalis** (anteriorly) and the **fascia iliaca** (posteriorly). It extends about 3–4 cm below the inguinal ligament. **1. Why the Femoral Nerve is the Correct Answer:** The **femoral nerve (L2–L4)** is the most important structure located **outside** the femoral sheath. It lies lateral to the sheath, separated from the femoral artery by the iliopsoas muscle and the fascia iliaca [2]. In the femoral triangle, the nerve lies in the groove between the psoas major and iliacus muscles. **2. Analysis of Incorrect Options:** The femoral sheath is divided into three compartments by vertical septa: * **Lateral Compartment:** Contains the **Femoral Artery** and the femoral branch of the genitofemoral nerve [1]. * **Intermediate Compartment:** Contains the **Femoral Vein**. * **Medial Compartment (Femoral Canal):** Contains **Lymphatics** (specifically the lymph node of Cloquet or Rosenmüller), loose areolar tissue, and small amounts of fat. **3. Clinical Pearls & High-Yield Facts for NEET-PG:** * **Femoral Canal:** The medial compartment is the site for **femoral hernias** [1]. Because the boundaries (especially the lacunar ligament) are rigid, femoral hernias are highly prone to strangulation. * **Nerve within the sheath:** Only the **femoral branch of the genitofemoral nerve** enters the lateral compartment of the sheath; the main femoral nerve does not. * **Mnemonic (NAVEL):** From Lateral to Medial: **N**erve (outside sheath), **A**rtery, **V**ein, **E**mpty space (Canal), **L**ymphatics. * **Length:** The sheath ends by fusing with the adventitia of the femoral vessels approximately 4 cm distal to the inguinal ligament.

Question 297: What is true regarding the semitendinosus muscle?

A. Supplied by the common peroneal part of the sciatic nerve
B. Proximal part is fleshy and distal part is thin
C. Distal part is fleshy and proximal part is thin
D. Proximal and distal parts are thin, with a middle fleshy part (Correct Answer)

Explanation: The **semitendinosus** is one of the three "hamstring" muscles located in the posterior compartment of the thigh. Its unique morphology is a frequent high-yield topic in anatomy. **1. Why Option D is Correct:** The semitendinosus is characterized by a long, cord-like tendon in its distal half. However, its proximal attachment is also narrow and tendinous. The muscle belly is situated in the middle, often interrupted by an oblique **tendinous intersection**. Therefore, the muscle is described as having thin proximal and distal portions with a fleshy middle part. **2. Why Other Options are Incorrect:** * **Option A:** All true hamstrings (except the short head of biceps femoris) are supplied by the **tibial part of the sciatic nerve**. The common peroneal part only supplies the short head of the biceps femoris. * **Options B & C:** These are incorrect descriptions of its morphology. While the distal half is famously "tendinous" (giving the muscle its name), the proximal origin is also not a broad fleshy mass but a tendon shared with the long head of the biceps femoris. **3. Clinical Pearls & High-Yield Facts for NEET-PG:** * **Origin:** Inferomedial part of the upper area of the ischial tuberosity (shared with the long head of biceps femoris). * **Insertion:** Upper part of the medial surface of the tibia (SGS area). * **SGS Complex:** The semitendinosus, along with the **S**artorius and **G**racilis, forms the **Pes Anserinus** (Goose’s foot) at the medial tibia. * **Clinical Use:** The tendon of the semitendinosus is commonly harvested as an **autograft for Anterior Cruciate Ligament (ACL) reconstruction**. * **Action:** Extension of the hip and flexion of the knee; it also medially rotates the flexed knee.

Question 298: A barefoot child steps on some glass on the sole of his foot and complains of numbness of the small toe. Which nerve has he most likely injured?

A. Lateral plantar (Correct Answer)
B. Tibial
C. Medial plantar
D. Superficial peroneal

Explanation: The correct answer is **Lateral plantar nerve**. This question tests the knowledge of the cutaneous innervation of the sole of the foot. **1. Why Lateral Plantar Nerve is Correct:** The sole of the foot is primarily supplied by the two terminal branches of the tibial nerve: the medial and lateral plantar nerves. The **lateral plantar nerve** provides sensory innervation to the lateral one-third of the sole and the **lateral 1.5 toes** (the small toe and the lateral half of the fourth toe). Since the child has numbness specifically in the small toe after a penetrating injury to the sole, the lateral plantar nerve is the most likely structure damaged. **2. Why Other Options are Incorrect:** * **Tibial Nerve:** While this is the parent nerve, it divides into the plantar nerves *above* or at the level of the flexor retinaculum. An injury on the sole itself would affect the distal branches, not the main trunk. * **Medial Plantar Nerve:** This nerve supplies the medial two-thirds of the sole and the **medial 3.5 toes**. Injury here would cause numbness in the great toe, second, third, and medial half of the fourth toe. * **Superficial Peroneal Nerve:** This nerve supplies the skin of the **dorsum of the foot** (except the first web space). It does not provide sensation to the sole. **Clinical Pearls for NEET-PG:** * **Analogy to Hand:** The distribution of the medial and lateral plantar nerves in the foot is analogous to the **median and ulnar nerves** in the hand, respectively. * **Motor Supply:** The lateral plantar nerve supplies most of the intrinsic muscles of the foot (similar to the ulnar nerve), while the medial plantar nerve supplies only four: Abductor hallucis, Flexor digitorum brevis, Flexor hallucis brevis, and the 1st Lumbrical (Mnemonic: **LAFF** muscles). * **Heel Sensation:** The skin of the heel is supplied by the **medial calcaneal branches** of the tibial nerve, which arise before the nerve divides into plantar branches.

Question 299: Which nerve supplies the muscles of the medial compartment of the thigh?

A. Femoral nerve
B. Obturator nerve (Correct Answer)
C. Tibial nerve
D. Common peroneal nerve

Explanation: ### Explanation The thigh is divided into three anatomical compartments, each with a primary nerve supply and specific functional role. **1. Why the Obturator Nerve is Correct:** The **Obturator nerve (L2–L4)**, a branch of the lumbar plexus, is the primary motor nerve for the **medial (adductor) compartment** of the thigh. It passes through the obturator canal to supply the Adductor longus, Adductor brevis, Gracilis, and the anterior part of the Adductor magnus. Its primary function is hip adduction. **2. Why the Other Options are Incorrect:** * **Femoral Nerve (L2–L4):** Supplies the **anterior compartment** (extensors of the knee), including the Quadriceps femoris, Sartorius, and Pectineus. * **Tibial Nerve (L4–S3):** A component of the Sciatic nerve that supplies the **posterior compartment** (hamstrings) and the "hamstring part" of the Adductor magnus. * **Common Peroneal Nerve (L4–S2):** The other component of the Sciatic nerve; it supplies the short head of the Biceps femoris in the thigh but primarily serves the lateral and anterior compartments of the **leg**. **3. High-Yield Clinical Pearls for NEET-PG:** * **Hybrid/Composite Muscle:** The **Adductor magnus** has a dual nerve supply: the adductor part by the Obturator nerve and the hamstring part by the Tibial nerve. * **Pectineus:** Often called the "frictional nerve" muscle, it is usually supplied by the Femoral nerve but may receive a branch from the Accessory Obturator nerve (present in 29% of cases). * **Obturator Externus:** This is the only lateral rotator of the hip supplied by the Obturator nerve. * **Hilton’s Law:** The Obturator nerve supplies the hip and knee joints, explaining why hip pathology (like Perthes disease) can present as referred pain to the medial knee.

Question 300: What is the cutaneous nerve supply of the region marked X?

A. Superficial peroneal nerve
B. Deep peroneal nerve (Correct Answer)
C. Medial plantar nerve
D. Saphenous nerve

Explanation: ***Deep peroneal nerve*** - Provides **cutaneous innervation** exclusively to the **first dorsal web space** between the great toe and second toe. - This is a **classic anatomical landmark** frequently tested in Indian PG exams as a one-liner fact. *Superficial peroneal nerve* - Innervates the **dorsum of the foot** except the first web space and lateral border of the little toe. - Does **not supply** the specific region between the great toe and second toe. *Medial plantar nerve* - Supplies the **plantar surface** of the medial three and a half toes, not the dorsal web space. - Functions on the **sole of the foot**, not the dorsal aspect where region X is located. *Saphenous nerve* - Provides cutaneous supply to the **medial aspect of the foot** and lower leg. - Does **not innervate** the first dorsal web space between the toes.

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Gluteal Region and Hip

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Thigh and Popliteal Fossa

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Leg and Foot

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Joints of Lower Limb

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Nerves of Lower Limb

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Arterial Supply and Venous Drainage

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Lymphatic Drainage

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Muscles and Their Actions

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Gait Analysis and Biomechanics

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Lower Limb — MCQs

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