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 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: 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: 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: 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.

Q: Which of the following statements about the popliteus muscle is false?

Causes locking of knee. ***Causes locking of knee*** - The popliteus muscle acts as the key to **unlocking the knee** from its fully extended, locked position, not causing it to lock. [1] - It achieves this by producing **internal rotation of the tibia** on the femur (or external rotation of the femur on the tibia) at the beginning of knee flexion. *Flexor of knee* - The popliteus muscle contributes to **flexion of the knee joint**, working in conjunction with the hamstrings. - This action is particularly important during the initial phases of knee flexion. *Intracapsular origin* - The popliteus muscle originates from the **lateral condyle of the femur**, specifically from an impression just anterior and inferior to the groove for the popliteal tendon. - This origin point is indeed **intracapsular**, lying within the fibrous capsule of the knee joint. *Supplied by tibial nerve* - The popliteus muscle receives its innervation from the **tibial nerve**, a branch of the sciatic nerve. - The nerve typically arises from the posterior aspect of the tibial nerve trunk as it passes through the popliteal fossa.

Q: 3rd and 4th lumbrical (lateral two lumbricals) of foot are supplied by ?

Lateral plantar nerve. ***Lateral plantar nerve*** - The **lateral plantar nerve** innervates the **lateral two lumbricals (3rd and 4th)** of the foot, mirroring the ulnar nerve's innervation of the medial two lumbricals in the hand. - This nerve is a branch of the **tibial nerve** and is responsible for motor innervation to most of the intrinsic foot muscles, including those in the lateral and central compartments. *Medial plantar nerve* - The **medial plantar nerve** supplies the **medial two lumbricals (1st and 2nd)** of the foot, similar to the median nerve in the hand. - It also provides motor innervation to the flexor digitorum brevis, abductor hallucis, and flexor hallucis brevis muscles. *Peroneal nerve* - The **peroneal nerve (fibular nerve)** is primarily responsible for innervating muscles in the **anterior and lateral compartments of the leg**, which control dorsiflexion and eversion of the foot. - It does not innervate the lumbrical muscles of the foot. *None of the options* - This option is incorrect because the **lateral plantar nerve** does specifically innervate the 3rd and 4th lumbricals of the foot.

Q: Injury at which of the following marked sites most specifically causes foot drop accompanied by impaired eversion and dorsolateral foot sensory loss from common fibular nerve injury?

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 **saphenous nerve**, which provides sensory innervation to the medial leg. The **tibial nerve** runs in the posterior leg and primarily innervates muscles for plantarflexion and inversion of the foot. - 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: 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 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.

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 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 3

Superficial epigastric artery is a branch of?

Accepted Answer

Femoral artery

Answer

Internal pudendal artery

Answer

External pudendal artery

Answer

Internal iliac artery

Question 4

Hunter's canal is seen in?

Accepted Answer

Thigh

Answer

Cubital fossa

Answer

Popliteal fossa

Answer

Calf

Question 5

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

Question 6

Which of the following statements about the popliteus muscle is false?

Accepted Answer

Causes locking of knee

Answer

Intracapsular origin

Answer

Supplied by tibial nerve

Answer

Flexor of knee

Question 7

3rd and 4th lumbrical (lateral two lumbricals) of foot are supplied by ?

Accepted Answer

Lateral plantar nerve

Answer

Medial plantar nerve

Answer

Peroneal nerve

Answer

None of the options

Question 8

Injury at which of the following marked sites most specifically causes foot drop accompanied by impaired eversion and dorsolateral foot sensory loss from common fibular nerve injury?

Accepted Answer

Lateral aspect of the leg (site 3)

Answer

Posterior aspect of the thigh (site 2)

Answer

Medial aspect of the leg (site 4)

Answer

Anterior aspect of the thigh (site 1)

Question 9

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 10

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

Lower Limb — MCQs

Lower Limb — MCQs

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