Lower Limb Practice Questions

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: 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: Locking of the knee involves which of the following?

Internal rotation of the femur with the foot on the ground. ***Internal rotation of the femur with the foot on the ground*** - When the foot is on the ground (closed kinematic chain), the **femur rotates internally on the tibia** during the end stages of knee extension. This creates a more stable, "locked" position of the knee. - This **terminal rotation of the femur** increases the contact area and tension in the cruciate ligaments, enhancing joint stability for weight-bearing. *Internal rotation of the tibia with the foot on the ground* - This describes the action of the **popliteus muscle** when "unlocking" the knee from full extension, not the locking mechanism itself. - With the foot on the ground, the tibia is fixed, and internal rotation would typically be a movement for unlocking, not locking. *Contraction of the popliteus muscle* - The **popliteus muscle** is primarily responsible for **unlocking the knee** from full extension, by causing internal rotation of the tibia (or external rotation of the femur). - Its contraction would lead to initial flexion of the knee, releasing the locked position, not establishing it. *External rotation of femur with the foot off the ground* - With the foot off the ground (open kinematic chain), **external rotation of the tibia** occurs during the final degrees of extension to lock the knee, not external rotation of the femur. - The locking mechanism requires specific relative rotation between femur and tibia; external rotation of the femur alone would not achieve the screw-home mechanism necessary for knee locking.

Q: Which structure is contained within the femoral canal?

Deep inguinal lymph node. ***Deep inguinal lymph node*** - The **femoral canal** contains several structures: a **lymph node (of Cloquet or Rosenmüller)**, **lymphatic vessels**, and **loose areolar tissue**. [1] - Among these contents, the **deep inguinal lymph node** (also called the lymph node of Cloquet or Rosenmüller) is the **most clinically significant and specifically named structure**. - This lymph node is an important anatomical landmark, serving as a sentinel node that drains lymph from the lower limb, external genitalia, and perineum. - **Clinically**, it is the structure most commonly referenced when discussing femoral canal contents, particularly in the context of femoral hernias and lymphatic drainage patterns. [1] *Loose areolar tissue and fat* - While **loose areolar tissue and fat** are indeed present within the femoral canal, they are **supporting contents** rather than specifically named anatomical structures. [1] - These tissues fill the space and allow for expansion of adjacent vessels (femoral artery and vein), but they are not the primary structure of anatomical or clinical significance. - When asked about "the structure" in the femoral canal, the named lymph node is the more specific answer. *Lymphatic vessels* - **Lymphatic vessels** do traverse the femoral canal, but they are **conduits** rather than a discrete, named structure. [1] - These vessels drain lymph towards the deep inguinal lymph node (of Cloquet) located within the same canal. - The specifically named lymph node is the more definitive anatomical answer than the unnamed vessels passing through. *Femoral vein* - The **femoral vein** is located in the **intermediate compartment of the femoral sheath**, NOT within the femoral canal. - The femoral sheath has three compartments: lateral (femoral artery), intermediate (femoral vein), and medial (femoral canal). - The femoral vein lies lateral to the femoral canal, making this option clearly incorrect.

Q: Inversion and eversion of foot occurs at which joint

Subtalar. ***Subtalar*** - The **subtalar joint** (talocalcaneal joint) is primarily responsible for **inversion** and **eversion** movements of the foot. - **Inversion** involves tilting the sole of the foot medially (turning inward), while **eversion** involves tilting the sole laterally (turning outward). - This joint allows the foot to **adapt to uneven surfaces** and plays a crucial role in the biomechanics of walking and running. - The subtalar joint is essential for shock absorption and balance during gait. *Ankle* - The **ankle joint** (talocrural joint) is a hinge joint primarily responsible for **dorsiflexion** and **plantarflexion** of the foot. - It allows moving the foot up and down but has minimal contribution to inversion and eversion. *Tarso-metatarsal* - The **tarso-metatarsal joints** (Lisfranc joints) connect the tarsal bones to the metatarsal bones. - These joints contribute primarily to the **stability and arch integrity** of the foot, with minimal movement capacity. - They allow slight gliding movements but not significant inversion or eversion. *None of the options* - This option is incorrect because the **subtalar joint** is indeed the primary joint responsible for inversion and eversion of the foot. - Understanding foot joint biomechanics is essential for diagnosing gait abnormalities, ankle sprains, and foot pathologies.

Q: Which of the following muscles is not supplied by the femoral nerve?

Obturator externus. ***Obturator externus*** - The **obturator externus** muscle is primarily supplied by the **obturator nerve** (L3-L4), which arises from the lumbar plexus, not the femoral nerve. - Its main function is the **lateral rotation of the thigh** at the hip joint. *Pectineus* - The **pectineus** muscle receives dual innervation, typically from both the **femoral nerve** (L2-L4) and the obturator nerve. - It aids in **adduction**, **flexion**, and **medial rotation** of the thigh. *Sartorius* - The **sartorius** muscle is entirely supplied by the **femoral nerve** (L2-L3). - It is responsible for **flexing, abducting, and laterally rotating the thigh** at the hip, and flexing the leg at the knee. *Vastus medialis* - The **vastus medialis** is one of the four muscles forming the quadriceps femoris group, all of which are exclusively supplied by the **femoral nerve** (L2-L4). - This muscle is crucial for **extending the leg** at the knee joint.

Q: Which of the following prevents hyperextension of the thigh?

Iliofemoral ligament. ***Iliofemoral ligament*** - The **iliofemoral ligament** is the strongest ligament in the hip joint and forms an inverted Y-shape. - Its primary function is to prevent **hyperextension of the thigh** by spiraling around the femoral neck and tightening during extension. *Ischiofemoral ligament* - The **ischiofemoral ligament** is located posteriorly and prevents **over-adduction** and **internal rotation** of the hip. - It also contributes to restricting hyperextension, but is not the primary restraint compared to the iliofemoral ligament. *Patellofemoral ligament* - The **patellofemoral ligament** is located in the knee joint, connecting the patella to the femur. - It stabilizes the **patella** and helps prevent its lateral dislocation, having no role in thigh hyperextension. *Puboischial ligament* - The term **puboischial ligament** is not a standard anatomical term for a hip joint ligament that prevents hyperextension. - This option likely refers to a combination of parts of the hip bone or other ligaments without a clear function related to thigh hyperextension.

Q: Which artery is primarily responsible for supplying the head and neck of the femur?

Medial circumflex artery. ***Medial circumflex artery*** - The **medial circumflex artery** is the primary blood supply to the **femoral head and neck** in adults. - Its branches, particularly the **retinacular arteries**, ascend along the femoral neck to perfuse the head. *Lateral circumflex artery* - The **lateral circumflex artery** supplies the **vastus lateralis muscle** and contributes to the supply of the **greater trochanter**. - While it anastomoses with the medial circumflex artery, its direct contribution to the femoral head is minimal. *Profunda femoris artery* - The **profunda femoris artery**, or deep femoral artery, is the main arterial supply to the **thigh muscles**. - It gives rise to the medial and lateral circumflex femoral arteries but does not directly supply the femoral head. *Obturator artery* - The **obturator artery** primarily supplies the **adductor muscles** of the thigh and contributes branches to the hip joint capsule. - While it has a small branch (artery to the head of the femur) that may contribute to the femoral head in children, it is not the main source in adults.

Q: Which of the following statements is true about the anatomy of the great saphenous vein?

Ascends anterior to the medial malleolus.. ***Ascends anterior to the medial malleolus.*** - The **great saphenous vein (GSV)** originates on the dorsum of the foot and passes **anterior to the medial malleolus** to ascend the medial side of the leg [1]. - This anatomical landmark is **consistently present** and crucial for identifying the vein during clinical procedures such as venous cutdown and physical examination [1]. - The GSV continues to ascend along the medial aspect of the leg and thigh to terminate at the saphenofemoral junction. *Ends at the femoral vein 2.5 cm below the inguinal ligament.* - The GSV terminates by joining the **femoral vein** at the **saphenofemoral junction** in the femoral triangle. - This junction is located approximately **3-4 cm below and lateral to the pubic tubercle**, not simply 2.5 cm below the inguinal ligament. - The precise location varies among individuals. *Starts as a continuation of the medial marginal vein.* - The GSV is formed by the union of the **dorsal vein of the great toe** and the **dorsal venous arch** of the foot. - While the **medial marginal vein** is part of the superficial venous system of the foot and contributes to the dorsal venous arch, it is not accurate to say the GSV is a direct continuation of the medial marginal vein alone. *There are usually more than 5 valves below the knee.* - While this statement might seem plausible, there is **significant individual variation** in valve numbers. - The GSV typically has **5-10 valves below the knee**, meaning some individuals have exactly 5, while others have more. - The phrase "usually more than 5" is **imprecise** and not universally true, making it an incorrect statement for exam purposes. - In contrast, the anterior position relative to the medial malleolus is a **constant anatomical feature** [1].

Q: The structure which lies outside the femoral sheath is:

Femoral nerve. ***Femoral nerve*** - The **femoral nerve** lies lateral to the femoral artery and is therefore situated outside the **femoral sheath**, which encloses the femoral artery, femoral vein, and lymphatic vessels [2]. - It originates from the lumbar plexus (L2-L4) and provides motor innervation to the quadriceps femoris and sensory innervation to the anterior thigh and medial leg. *Femoral artery* - The **femoral artery** is a primary content of the **femoral sheath**, occupying the most lateral compartment. - It is a continuation of the external iliac artery and is a major blood supply to the lower limb. *Femoral vein* - The **femoral vein** lies within the **femoral sheath**, positioned medial to the femoral artery. - It is the primary vein responsible for draining blood from the lower limb and eventually becomes the external iliac vein. *Genitofemoral nerve* - The **genitofemoral nerve** typically emerges on the anterior surface of the psoas major muscle and then usually divides into genital and femoral branches [1]. - While its femoral branch supplies sensory innervation to the skin over the femoral triangle, it does not course within the femoral sheath itself but rather anterior to it or outside its immediate vicinity [1].

Question 1

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 2

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 3

Locking of the knee involves which of the following?

Accepted Answer

Internal rotation of the femur with the foot on the ground

Answer

Internal rotation of the tibia with the foot on the ground

Answer

Contraction of the popliteus muscle

Answer

External rotation of femur with the foot off the ground

Question 4

Which structure is contained within the femoral canal?

Accepted Answer

Deep inguinal lymph node

Answer

Loose areolar tissue and fat

Answer

Lymphatic vessels

Answer

Femoral vein

Question 5

Inversion and eversion of foot occurs at which joint

Accepted Answer

Subtalar

Answer

Ankle

Answer

Tarso-metatarsal

Answer

None of the options

Question 6

Which of the following muscles is not supplied by the femoral nerve?

Accepted Answer

Obturator externus

Answer

Pectineus

Answer

Sartorius

Answer

Vastus medialis

Question 7

Which of the following prevents hyperextension of the thigh?

Accepted Answer

Iliofemoral ligament

Answer

Ischiofemoral ligament

Answer

Patellofemoral ligament

Answer

Puboischial ligament

Question 8

Which artery is primarily responsible for supplying the head and neck of the femur?

Accepted Answer

Medial circumflex artery

Answer

Obturator artery

Answer

Lateral circumflex artery

Answer

Profunda femoris artery

Question 9

Which of the following statements is true about the anatomy of the great saphenous vein?

Accepted Answer

Ascends anterior to the medial malleolus.

Answer

Ends at the femoral vein 2.5 cm below the inguinal ligament.

Answer

Starts as a continuation of the medial marginal vein.

Answer

There are usually more than 5 valves below the knee.

Question 10

The structure which lies outside the femoral sheath is:

Accepted Answer

Femoral nerve

Answer

Genitofemoral nerve

Answer

Femoral vein

Answer

Femoral artery

Lower Limb — MCQs

Lower Limb — MCQs

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