Lower Limb Practice Questions

Q: Posterior gliding of tibia on femur is prevented by?

Posterior cruciate ligament. ***Posterior cruciate ligament*** - The **posterior cruciate ligament (PCL)** is the primary restraint to **posterior tibial translation** relative to the femur. - It prevents the **tibia from sliding backward** on the femur, especially during knee flexion and weight-bearing activities. *Anterior cruciate ligament* - The **anterior cruciate ligament (ACL)** primarily prevents **anterior tibial translation** (tibia sliding forward) relative to the femur. - It also plays a role in controlling **rotational stability** of the knee. *Medial collateral ligament* - The **medial collateral ligament (MCL)** provides stability to the **medial side of the knee**, resisting **valgus stress** (force from the outside). - It prevents the shin bone from going too far outward relative to the thigh bone. *Lateral collateral ligament* - The **lateral collateral ligament (LCL)** provides stability to the **lateral side of the knee**, resisting **varus stress** (force from the inside). - It prevents the shin bone from going too far inward relative to the thigh bone.

Q: Which muscle plays a key role in preventing lateral dislocation of the patella?

Vastus medialis. ***Vastus medialis*** - The **vastus medialis obliquus (VMO)** fibers pull the patella medially, counteracting the natural lateral pull exerted by the quadriceps femoris. - Its strength and proper activation are crucial in maintaining **patellar tracking** and preventing lateral subluxation or dislocation. *Rectus femoris* - The **rectus femoris** primarily acts as a hip flexor and knee extensor, with its pull being largely in the superior-inferior direction. - While it contributes to knee extension, its role in **medial stabilization** of the patella is minimal. *Vastus intermedius* - The **vastus intermedius** lies deep to the rectus femoris and primarily contributes to knee extension. - Its fibers run predominantly in the superior-inferior direction, offering little direct lateral-to-medial pull on the patella for stability. *Vastus lateralis* - The **vastus lateralis** pulls the patella in a superior and lateral direction, increasing the tendency for **lateral patellar dislocation**. - An imbalance where the vastus lateralis is significantly stronger or more active than the vastus medialis often contributes to patellar instability.

Q: Which of the following statements about the tibia and fibula is FALSE?

Proximal end of tibia is related to common peroneal nerve. ***Proximal end of tibia is related to common peroneal nerve*** - This statement is **FALSE** and is the correct answer to this question. - The **common peroneal nerve** (common fibular nerve) winds around the **neck of the fibula**, NOT the proximal end of the tibia. - The nerve is vulnerable to injury at the fibular neck due to its superficial location, which can result in **foot drop** and sensory deficits over the dorsum of the foot. - The proximal tibia forms the knee joint and is related to structures like the patellar ligament and pes anserinus, but not the common peroneal nerve. *Tibia is the most common site of osteomyelitis* - This statement is debatable but **not clearly false**. - The **tibia** and **femur** are among the most commonly affected bones in osteomyelitis, particularly in children. - The metaphyseal regions of long bones (including proximal and distal tibia, distal femur) are frequently involved due to their rich vascular supply and slower blood flow in metaphyseal vessels. - While some sources cite the femur as slightly more common, the tibia is certainly one of the top sites. *Nutrient artery of tibia is from posterior tibial artery* - This statement is **TRUE**. - The **nutrient artery of the tibia** originates from the **posterior tibial artery** near its origin. - It enters the tibia on its posterior surface and provides blood supply to the diaphyseal cortex and medullary cavity. *Nutrient artery of fibula is from peroneal artery* - This statement is **TRUE**. - The **nutrient artery of the fibula** arises from the **peroneal artery** (fibular artery). - It enters the fibula on its posterior surface and supplies the fibular shaft.

Q: Superficial epigastric artery is a branch of?

Femoral artery. ***Femoral artery*** - The **superficial epigastric artery** is one of the initial branches that arises directly from the **femoral artery** in the femoral triangle, just below the inguinal ligament. - It supplies the **skin** and **superficial fascia** over the lower part of the anterior abdominal wall and the superficial inguinal lymph nodes [1]. *Internal pudendal artery* - The **internal pudendal artery** is a branch of the **internal iliac artery** and primarily supplies structures in the perineum and genitalia. - It does not supply the anterior abdominal wall. *External pudendal artery* - The **external pudendal artery** is also a branch of the **femoral artery**, but it supplies the skin of the external genitalia (scrotum/labia majora) and adjacent thigh. - It does not supply the superficial epigastric region. *Internal iliac artery* - The **internal iliac artery** primarily supplies the pelvic organs, gluteal region, and medial thigh. - While it has many branches, the superficial epigastric artery is not one of them.

Q: Which ligament provides inferior support to the head of the talus?

Spring ligament. ***Spring ligament*** - The **spring ligament** (plantar calcaneonavicular ligament) supports the head of the **talus**, maintaining the **medial longitudinal arch** of the foot. - Its failure can lead to **pes planus** (flat foot) due to loss of talar support. *Deltoid ligament* - The **deltoid ligament** is a strong medial ankle ligament that stabilizes the ankle joint by connecting the **tibia** to the **navicular**, **calcaneus**, and **talus**, but primarily supports the talus against eversion. - It primarily resists **eversion** and is not the primary ligament supporting the talar head's position. *Lateral collateral ligament (LCL)* - The **lateral collateral ligament** of the ankle consists of three parts (anterior talofibular, posterior talofibular, and calcaneofibular ligaments) that stabilize the ankle joint on the lateral side. - Its primary role is to resist **inversion** and is not directly responsible for supporting the talus from below. *Cervical ligament* - The **cervical ligament** is located in the **sinus tarsi** of the foot, connecting the **calcaneus** to the **talus**. - Its main function is to restrict **subtalar joint movements** and provide proprioception, rather than directly supporting the main body of the talus.

Q: Which of the following statements is true about the inferior extensor retinaculum?

Y shaped. ***Y shaped*** - The **inferior extensor retinaculum** is indeed described as a **Y-shaped** band of deep fascia located on the anterior aspect of the ankle. - This characteristic shape is its most distinctive and clinically important feature, with the stem attaching to the calcaneus, the upper limb extending to the medial malleolus, and the lower limb blending with the plantar aponeurosis. *Inferior slip attached to calcaneum* - While the **stem** of the Y-shaped retinaculum does attach to the **anterosuperior surface of the calcaneum**, describing this as simply "inferior slip attached to calcaneum" is imprecise and incomplete. - The inferior (lower) limb of the Y actually extends **medially** from the stem to blend with the plantar aponeurosis, not directly to the calcaneum. - This statement is partially true but less specific and accurate than the Y-shaped description. *Lateral attached to talus* - The **lateral attachment** of the inferior extensor retinaculum is primarily to the **lateral aspect of the calcaneum**, not the talus. - The stem of the Y attaches to the calcaneus on its lateral side (anterosuperior surface). *Superior slip attached to lower end of fibula* - The **superior (upper) limb** of the inferior extensor retinaculum attaches to the **medial malleolus** (distal tibia), not the lateral malleolus (lower end of fibula). - The lateral malleolus of the fibula is associated with the superior extensor retinaculum, not the inferior one.

Q: Injury at which of the following marked sites on the leg causes failure of dorsiflexion?

Lateral aspect of the leg (site 3). ***Lateral aspect of the leg (site 3)*** - Site 3 points to the **fibula head** and the adjacent region on the lateral aspect of the leg. This is the anatomical location where the **common fibular nerve (peroneal nerve)** wraps around. - The common fibular nerve innervates the muscles responsible for **dorsiflexion** and eversion of the foot. Damage to this nerve, often due to trauma at the fibular neck, leads to **foot drop** and an inability to dorsiflex the foot. *Anterior aspect of the thigh (site 1)* - Site 1 points to the distal femur, which is part of the thigh. Nerves in the anterior thigh (e.g., **femoral nerve**) primarily control hip flexion and knee extension. - Damage here would affect movements of the hip and knee, not directly causing failure of dorsiflexion of the foot. *Medial aspect of the leg (site 4)* - Site 4 points to the medial tibia. This area is associated with the **tibial nerve** and saphenous nerve, which primarily innervate muscles for plantarflexion and inversion of the foot, or provide sensory innervation. - Injury to the tibial nerve would result in an inability to plantarflex and invert the foot, not dorsiflexion. *Posterior aspect of the thigh (site 2)* - Site 2 points to the posterior aspect of the thigh, which is the region for the hamstrings. The **sciatic nerve** and its branches (tibial and common fibular) pass through this region. - While the common fibular nerve originates from the sciatic nerve in the posterior thigh, an injury at this level would likely cause more widespread motor and sensory deficits than isolated dorsiflexion failure, and site 3 is a more common and specific site for common fibular nerve injury isolated to foot drop.

Q: Hunter's canal is seen in?

Thigh. ***Thigh*** - **Hunter's canal**, also known as the **adductor canal**, is an intermuscular passageway located in the **middle third of the thigh**. - It transmits the **femoral artery and vein**, the **saphenous nerve**, and the **nerve to the vastus medialis**. *Cubital fossa* - The **cubital fossa** is a triangular depression located anterior to the elbow joint. - It contains structures like the **brachial artery**, **median nerve**, and biceps tendon, but not Hunter's canal. *Popliteal fossa* - The **popliteal fossa** is a diamond-shaped space located posterior to the knee joint. - It contains the **popliteal artery and vein**, **tibial and common fibular nerves**, and lymph nodes, but not Hunter's canal. *Calf* - The **calf** refers to the posterior compartment of the lower leg. - It houses muscles like the gastrocnemius and soleus, as well as the tibial nerve and posterior tibial artery, but not Hunter's canal.

Q: Which of the following muscles is responsible for dorsiflexing the foot?

Tibialis anterior. ***Tibialis anterior*** - The **tibialis anterior** is the **primary muscle responsible for dorsiflexion** of the foot, which means lifting the foot upwards towards the shin. - It also aids in **inversion** of the foot. - While other muscles like extensor hallucis longus and extensor digitorum longus also contribute to dorsiflexion, the tibialis anterior is the most powerful and clinically significant dorsiflexor. *Tibialis posterior* - The **tibialis posterior** primarily functions in **plantarflexion** and **inversion** of the foot and plays a crucial role in supporting the medial arch. - Its action is opposite to dorsiflexion. *Peroneus brevis* - The **peroneus brevis** (also known as fibularis brevis) is involved in **plantarflexion** and **eversion** of the foot. - It helps stabilize the ankle joint during gait. *Extensor digitorum brevis* - The **extensor digitorum brevis** is a muscle on the dorsal aspect of the foot that extends the toes, specifically the second to fourth toes. - It does not significantly contribute to dorsiflexion of the entire foot.

Q: All are true about short saphenous vein except which one?

Runs on lateral side of leg. ***Runs on lateral side of leg*** - The **short saphenous vein** is located on the **posterior aspect** of the calf, beginning behind the lateral malleolus and ascending the back of the leg. - While it originates on the lateral side of the foot, its primary course is **posterior**, not strictly lateral, making this statement the exception or incorrect. *Runs behind lateral malleolus* - The **short saphenous vein** (SSV) originates from the dorsal venous arch of the foot and passes **posterior to the lateral malleolus**. - This is a well-established anatomical landmark for the beginning of the SSV's course up the calf. *Accompanied by sural nerve* - The **sural nerve** travels closely with the **short saphenous vein** along its course up the posterior calf. - This anatomical relationship is clinically significant, especially in procedures involving the SSV. *Achilles tendon is medial to vein* - As the **short saphenous vein** ascends the posterior calf, it lies between the **Achilles tendon** (medially) and the lateral border of the fibula. - Therefore, the **Achilles tendon** is indeed **medial** to the short saphenous vein.

Question 1

Posterior gliding of tibia on femur is prevented by?

Accepted Answer

Posterior cruciate ligament

Answer

Anterior cruciate ligament

Answer

Medial collateral ligament

Answer

Lateral collateral ligament

Question 2

Which muscle plays a key role in preventing lateral dislocation of the patella?

Accepted Answer

Vastus medialis

Answer

Rectus femoris

Answer

Vastus intermedius

Answer

Vastus lateralis

Question 3

Which of the following statements about the tibia and fibula is FALSE?

Accepted Answer

Proximal end of tibia is related to common peroneal nerve

Answer

Tibia is the most common site of osteomyelitis

Answer

Nutrient artery of tibia is from posterior tibial artery

Answer

Nutrient artery of fibula is from peroneal artery

Question 4

Superficial epigastric artery is a branch of?

Accepted Answer

Femoral artery

Answer

Internal pudendal artery

Answer

External pudendal artery

Answer

Internal iliac artery

Question 5

Which ligament provides inferior support to the head of the talus?

Accepted Answer

Spring ligament

Answer

Deltoid ligament

Answer

Lateral collateral ligament (LCL)

Answer

Cervical ligament

Question 6

Which of the following statements is true about the inferior extensor retinaculum?

Accepted Answer

Y shaped

Answer

Inferior slip attached to calcaneum

Answer

Lateral attached to talus

Answer

Superior slip attached to lower end of fibula

Question 7

Injury at which of the following marked sites on the leg causes failure of dorsiflexion?

Accepted Answer

Lateral aspect of the leg (site 3)

Answer

Anterior aspect of the thigh (site 1)

Answer

Medial aspect of the leg (site 4)

Answer

Posterior aspect of the thigh (site 2)

Question 8

Hunter's canal is seen in?

Accepted Answer

Thigh

Answer

Cubital fossa

Answer

Popliteal fossa

Answer

Calf

Question 9

Which of the following muscles is responsible for dorsiflexing the foot?

Accepted Answer

Tibialis anterior

Answer

Tibialis posterior

Answer

Peroneus brevis

Answer

Extensor digitorum brevis

Question 10

All are true about short saphenous vein except which one?

Accepted Answer

Runs on lateral side of leg

Answer

Accompanied by sural nerve

Answer

Achilles tendon is medial to vein

Answer

Runs behind lateral malleolus

Lower Limb — MCQs

Lower Limb — MCQs

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