Lower Limb Practice Questions

Q: Trendelenburg test is positive due to injury to which of the following nerves?

Superior Gluteal nerve. ***Superior Gluteal nerve*** - A positive **Trendelenburg test** indicates weakness of the **gluteus medius** and **gluteus minimus** muscles, which are innervated by the **superior gluteal nerve**. - Injury to this nerve leads to the characteristic pelvic drop on the unsupported side during ambulation or unilateral stance. *Obturator nerve* - The **obturator nerve** primarily innervates the **adductor muscles** of the thigh. - Injury to this nerve would cause weakness in **thigh adduction**, not gluteal muscle dysfunction or a positive Trendelenburg sign. *Inferior Gluteal nerve* - The **inferior gluteal nerve** supplies the **gluteus maximus**, which is a powerful extensor and external rotator of the hip. - Damage to this nerve primarily affects hip extension, making rising from a seated position or climbing stairs difficult, but does not cause a positive Trendelenburg test. *Sciatic nerve* - The **sciatic nerve** is the largest nerve in the body, innervating the posterior thigh muscles and all muscles below the knee. - Injury to the sciatic nerve would cause widespread motor and sensory deficits in the leg and foot, but not specifically the weakness typical of a positive Trendelenburg sign.

Q: In forceful inversion of the foot, fracture of the tuberosity of the 5th metatarsal is due to the pull exerted by which tendon?

Peroneus brevis. ***Peroneus brevis*** - The **peroneus brevis tendon** inserts onto the **tuberosity of the 5th metatarsal**. - During a **forceful inversion** injury, the foot is turned inward, stretching the lateral ankle structures and causing the peroneus brevis to strongly contract, leading to an **avulsion fracture** of its insertion point. *Peroneus longus* - The **peroneus longus tendon** inserts into the **medial cuneiform** and the **base of the first metatarsal**, not the 5th metatarsal tuberosity. - While it contributes to eversion, its pull is not directly responsible for avulsion fractures at the 5th metatarsal tuberosity. *Peroneus tertius* - The **peroneus tertius** is an extensor muscle that inserts on the **dorsal surface of the base of the 5th metatarsal**, not the tuberosity. - It assists with dorsiflexion and eversion, but its role in avulsion fractures of the tuberosity is minimal compared to the peroneus brevis. *Extensor digitorum (toe extension)* - The **extensor digitorum longus** tendonprimarily inserts onto the **phalanges of the lateral four toes** to extend them. - This tendon does not attach to the 5th metatarsal tuberosity and is not involved in this type of avulsion fracture.

Q: Sartorius muscle takes origin from which structure?

Anterior superior iliac spine. ***Anterior superior iliac spine*** - The **sartorius muscle**, the longest muscle in the body, originates from the **anterior superior iliac spine (ASIS)** and the upper half of the notch just below it. - This anatomical landmark is crucial for its function in **flexing, abducting, and laterally rotating the thigh**, as well as flexing the knee. *Pectinate line* - The **pectinate line** is an anatomical landmark found in the anal canal, marking the transition between the visceral and somatic innervation. - It plays no role in the origin of any major limb muscles. *Body of the ilium* - While other muscles like the **gluteus medius** and **minimus** originate from the external surface of the ala (body) of the ilium, the sartorius does not. - The **body of the ilium** contributes to the acetabulum and provides origin points for various hip muscles. *Ischial tuberosity* - The **ischial tuberosity** is the origin point for the **hamstring muscles** (semitendinosus, semimembranosus, and biceps femoris long head). - It is located on the ischium, which is part of the pelvic bone, but distinct from the origin of the sartorius.

Q: Coronary ligament is present between which two structures?

Tibia and meniscus. ***Tibia and meniscus*** - The **coronary ligaments** are fibrous bands that connect the inferior edges of the **menisci** to the **tibia**. - These ligaments play a crucial role in stabilizing the menisci on the tibial plateau, limiting their movement during knee joint activity. *Posterior horns of menisci* - The posterior horns of the menisci are connected to the tibia by other attachments, but the **coronary ligaments** specifically describe the circumferential attachments of the menisci to the tibial plateau. - While there are various attachments for the posterior horns, the coronary ligament is distinct in its **peripheral connection** to the tibia. *Femur and meniscus* - The menisci are primarily attached to the **tibia** via coronary ligaments and to each other by the **transverse ligament of the knee**. - There are no direct ligamentous connections between the femur and meniscus referred to as **coronary ligaments**. *Femur and tibia* - The femur and tibia are connected by major ligaments such as the **cruciate ligaments** (anterior and posterior) and the **collateral ligaments** (medial and lateral). - The **coronary ligaments** specifically connect the menisci to the tibia, not directly the femur to the tibia.

Q: Abduction of the thigh is limited by:

Pubofemoral ligaments. Abduction of the thigh is limited by: ***Pubofemoral ligaments*** - The **pubofemoral ligament** is positioned anteroinferiorly and becomes taut during **ADDUCTION** and **extension**, limiting these movements. - Note: This ligament primarily limits **adduction**, not abduction. Some sources suggest it may provide minimal limitation to abduction in certain hip positions, but its primary role is restricting adduction and extension. - This ligament prevents excessive adduction and extension at the **hip joint**, contributing to joint stability. *Ischiofemoral ligaments* - The **ischiofemoral ligament** is located posteriorly and becomes taut during **internal rotation** and **extension**, limiting these motions. - Its primary role is to restrict extreme movements in **internal rotation** and **hyperextension** of the hip. *Iliofemoral ligaments* - The **iliofemoral ligament** is the strongest ligament of the hip joint and is positioned anteriorly, limiting **extension** and **external rotation**. - The inferior/medial band can limit **adduction**, while the superior band limits extension. - It forms an inverted 'Y' shape, known as the **Y-ligament of Bigelow**, providing significant hip stability. *Sacroiliac ligament* - The **sacroiliac ligaments** connect the sacrum to the ilium, stabilizing the **sacroiliac joint**, not the hip joint. - These ligaments are crucial for maintaining the integrity of the **pelvic girdle** and supporting weight bearing. **Clinical Note:** Hip **abduction** is primarily limited by the adductor muscle group tension, inferior joint capsule, and bony contact with the acetabulum, rather than by specific ligamentous structures.

Q: A healthy young athlete is sitting at the edge of the table with the knee at 90 degrees of flexion. He then fully extends the knee. What happens to the patella?

Patella moves proximally in the trochlear groove. ***Patella moves proximally in the trochlear groove*** - During **knee extension** from a flexed position, the quadriceps femoris muscle contracts, pulling the patella superiorly along the **trochlear groove** of the femur. - This proximal movement optimizes the **lever arm** of the quadriceps, enhancing efficiency of extension. *Patella moves distally in the trochlear groove* - The patella moves **distally (inferiorly)** during **knee flexion**, not extension, as it follows the femoral condyles and is pulled by gravity and the patellar ligament. - This distal movement brings the patella into a deeper part of the trochlear groove during flexion, which can lead to **increased patellofemoral contact pressure**. *Patella remains stationary* - The patella is a **sesamoid bone** embedded in the quadriceps tendon and patellar ligament, making it a dynamic structure that moves significantly with knee flexion and extension. - It acts as a **pulley** to change the direction of force in the quadriceps tendon, thus it cannot remain stationary during knee movement. *Patella moves posteriorly away from the femur* - The patella maintains close contact with the **femoral trochlear groove** throughout knee motion, gliding within it. - Moving posteriorly away from the femur would indicate **patellar subluxation or dislocation**, which is an abnormal event.

Q: Bursa involved in housemaid's knee:

Prepatellar bursa. ***Prepatellar bursa*** - **Housemaid's knee** refers to inflammation of the **prepatellar bursa**, located in front of the kneecap. - This condition is often due to **prolonged kneeling** while leaning forward, common in occupations such as housemaids or carpet layers who scrub floors or work on their knees. *Infrapatellar bursa* - The infrapatellar bursa is located **below the patella** and its inflammation is associated with **clergyman's knee** (superficial infrapatellar bursitis) from upright kneeling, or **jumper's knee** (deep infrapatellar bursitis) in athletes. - While it's in the knee region, it is not the bursa primarily involved in housemaid's knee. *Olecranon bursa* - The olecranon bursa is located at the **tip of the elbow** and its inflammation is known as **student's elbow** or olecranon bursitis, often caused by repetitive pressure on the elbow. - It is not associated with knee conditions. *Ischial bursa* - The ischial bursa is situated over the **ischial tuberosity** in the buttock region. Inflammation here is called **weaver's bottom** or ischial bursitis, often due to prolonged sitting. - This bursa is located in the hip/buttock area and is unrelated to the knee.

Q: A man is struck with a lathi on the lateral aspect of the head of fibula. Which of the following sensory deficits can occur as a result of nerve injury?

Loss of sensation of adjacent sides of 1st & 2nd toe. ***Loss of sensation of adjacent sides of 1st & 2nd toe*** - Injury to the lateral aspect of the head of the fibula commonly damages the **common fibular (peroneal) nerve**, which then divides into superficial and deep fibular nerves. - The **deep fibular nerve** supplies sensation to the web space between the first and second toes, and its injury would cause loss of sensation in this specific area. - This is the correct **sensory deficit** resulting from common fibular nerve injury at the fibular head. *Loss of sensation of lateral foot* - Sensation to the lateral aspect of the foot is primarily supplied by the **sural nerve**, a branch of the tibial nerve, not the common fibular nerve. - Damage to the common fibular nerve would not typically result in isolated loss of sensation on the lateral foot. *Dorsiflexion not possible* - Inability to **dorsiflex** the foot ("foot drop") is a common consequence of common fibular nerve injury. - However, this is a **motor deficit**, not a **sensory deficit** as specifically asked in the question. - Dorsiflexion is performed by tibialis anterior and extensor digitorum longus, both innervated by the deep fibular nerve. *Inversion inability* - **Foot inversion** is primarily mediated by muscles innervated by the **tibial nerve** (tibialis posterior) and to a lesser extent by the deep fibular nerve (tibialis anterior). - This represents a **motor deficit**, not a **sensory deficit** as asked in the question. - Injury to the common fibular nerve would not significantly impair inversion since tibialis posterior (the primary invertor) remains intact.

Q: A 60-year-old male patient presented to the OPD with complaints of a mass in the epigastric region with no other complaints. On examination, the mass was found to be pulsatile. A USG abdomen and CT abdomen were performed. The doctor then performed a procedure, accessing an artery in the lower limb and opening a sheath to expose the artery. Which of the following structures is enclosed inside that sheath?

Femoral canal. ***Femoral canal*** - The description of accessing an artery in the lower limb and opening a sheath to expose it strongly suggests an intervention related to the **femoral artery**, which is part of the structures found in the femoral triangle [1]. - The **femoral sheath** encloses the femoral artery, femoral vein, and the femoral canal (which contains lymphatic vessels and a lymph node called the deep inguinal lymph node of Cloquet). The procedure likely involves accessing one of these [1]. *Cooper's ligament* - **Cooper's ligament** (pectineal ligament) is a fibrous band on the superior aspect of the superior pubic ramus and is involved in the inguinal region but is not part of the femoral sheath or directly accessed for arterial procedures in this context. - It serves as an attachment point for various structures but does not contain major vessels or nerves that would be exposed through this described sheath. *Femoral nerve* - The **femoral nerve** runs lateral to the femoral sheath and is not contained within it. It originates from the lumbar plexus and supplies the anterior thigh muscles. - Accessing the femoral artery for an interventional procedure would typically avoid direct involvement or opening a sheath around the femoral nerve. *Obturator nerve* - The **obturator nerve** is a branch of the lumbar plexus that passes through the obturator foramen to supply the medial compartment of the thigh. - It is anatomically distant from the femoral triangle and the femoral sheath and would not be encountered or enclosed in a sheath during a femoral artery access procedure.

Q: A 41-year-old man is admitted to the emergency department with a swollen and painful foot. Radiographic examination reveals that the head of the talus has become displaced inferiorly, thereby causing the medial longitudinal arch of the foot to fall. What is the most likely cause in this case?

Tearing of the plantar calcaneonavicular (spring) ligament. ***Tearing of the plantar calcaneonavicular (spring) ligament*** - The **plantar calcaneonavicular ligament**, also known as the **spring ligament**, is crucial for supporting the head of the talus and maintaining the **medial longitudinal arch** of the foot. - Tearing of this ligament leads to the **inferior displacement of the talar head** and subsequent collapse of the arch, consistent with the symptoms described. *Fracture of the navicular bone* - A fracture of the **navicular bone** would typically cause localized pain and tenderness over the navicular, and while it could contribute to arch instability, it wouldn't primarily cause the **talar head** to *inferiorly displace* in this specific manner. - While a navicular fracture might lead to secondary arch collapse, the primary issue described is the displacement of the **talar head**, which is more directly related to spring ligament integrity. *Tearing of the deltoid ligament* - The **deltoid ligament** is located on the medial side of the ankle and primarily stabilizes the **talocrural joint**, preventing excessive eversion of the foot. - Its rupture would lead to ankle instability and pain, but it doesn't directly support the **medial longitudinal arch** in the same way the spring ligament does, nor would its tearing directly cause the talar head to displace inferiorly as described. *Sprain of the calcaneocuboid ligament* - The **calcaneocuboid ligament** is a component of the **lateral longitudinal arch** of the foot and connects the calcaneus to the cuboid bone. - A sprain of this ligament would primarily affect the *lateral* foot stability and lead to pain in that region, not the described collapse of the **medial longitudinal arch** or inferior displacement of the talar head.

Question 1

Trendelenburg test is positive due to injury to which of the following nerves?

Accepted Answer

Superior Gluteal nerve

Answer

Obturator nerve

Answer

Inferior Gluteal nerve

Answer

Sciatic nerve

Question 2

In forceful inversion of the foot, fracture of the tuberosity of the 5th metatarsal is due to the pull exerted by which tendon?

Accepted Answer

Peroneus brevis

Answer

Peroneus longus

Answer

Peroneus tertius

Answer

Extensor digitorum (toe extension)

Question 3

Sartorius muscle takes origin from which structure?

Accepted Answer

Anterior superior iliac spine

Answer

Pectinate line

Answer

Body of the ilium

Answer

Ischial tuberosity

Question 4

Coronary ligament is present between which two structures?

Accepted Answer

Tibia and meniscus

Answer

Femur and meniscus

Answer

Posterior horns of menisci

Answer

Femur and tibia

Question 5

Abduction of the thigh is limited by:

Accepted Answer

Pubofemoral ligaments

Answer

Ischiofemoral ligaments

Answer

Iliofemoral ligaments

Answer

Sacroiliac ligament

Question 6

A healthy young athlete is sitting at the edge of the table with the knee at 90 degrees of flexion. He then fully extends the knee. What happens to the patella?

Accepted Answer

Patella moves proximally in the trochlear groove

Answer

Patella moves posteriorly away from the femur

Answer

Patella moves distally in the trochlear groove

Answer

Patella remains stationary

Question 7

Bursa involved in housemaid's knee:

Accepted Answer

Prepatellar bursa

Answer

Ischial bursa

Answer

Infrapatellar bursa

Answer

Olecranon bursa

Question 8

A man is struck with a lathi on the lateral aspect of the head of fibula. Which of the following sensory deficits can occur as a result of nerve injury?

Accepted Answer

Loss of sensation of adjacent sides of 1st & 2nd toe

Answer

Dorsiflexion not possible

Answer

Loss of sensation of lateral foot

Answer

Inversion inability

Question 9

A 60-year-old male patient presented to the OPD with complaints of a mass in the epigastric region with no other complaints. On examination, the mass was found to be pulsatile. A USG abdomen and CT abdomen were performed. The doctor then performed a procedure, accessing an artery in the lower limb and opening a sheath to expose the artery. Which of the following structures is enclosed inside that sheath?

Accepted Answer

Femoral canal

Answer

Cooper's ligament

Answer

Obturator nerve

Answer

Femoral nerve

Question 10

A 41-year-old man is admitted to the emergency department with a swollen and painful foot. Radiographic examination reveals that the head of the talus has become displaced inferiorly, thereby causing the medial longitudinal arch of the foot to fall. What is the most likely cause in this case?

Accepted Answer

Tearing of the plantar calcaneonavicular (spring) ligament

Answer

Fracture of the navicular bone

Answer

Tearing of the deltoid ligament

Answer

Sprain of the calcaneocuboid ligament

Lower Limb — MCQs

Lower Limb — MCQs

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