Lower Limb Practice Questions

Q: Which of the following statements accurately describes the location of the saphenous vein?

1cm anterior and 1cm superior to the medial malleolus. ***1cm anterior and 1cm superior to the medial malleolus*** [1] - This is the classic anatomical landmark for the **great saphenous vein (GSV)** at the ankle level [1]. - The vein passes both **anterior** and **superior** to the medial malleolus, making this dual landmark the most accurate for surgical identification [1]. - This position is crucial for procedures such as **venous cutdown**, **cannulation**, or assessing for **venous insufficiency**. *1cm posterior to the medial malleolus* - The structures posterior to the medial malleolus include the **tibial nerve**, **posterior tibial artery**, and **tibialis posterior tendon** (contents of the tarsal tunnel). - The **great saphenous vein** is not located in this area; attempting to access it there could damage surrounding neurovascular structures. *1cm inferior to the medial malleolus* - The area inferior to the medial malleolus refers to the plantar aspect of the foot or the distal ankle region. - The **great saphenous vein** is not consistently found in this location at the ankle level. *1cm superior to the medial malleolus* - While the vein does pass superior to the malleolus, this description is **incomplete** without also specifying the anterior position. - The precise landmark requires both coordinates: anterior AND superior to the medial malleolus.

Q: Muscles taking origin from the ischial tuberosity are all except:

Adductor longus. ***Adductor longus*** - The **adductor longus** originates from the anterior surface of the **pubic body**, inferior to the pubic crest. - It is part of the **adductor compartment of the thigh** but does not originate from the ischial tuberosity. *Semimembranosus* - The **semimembranosus** muscle originates from the **ischial tuberosity**, specifically from its upper and outer part. - It is one of the three **hamstring muscles**. *Semitendinosus* - The **semitendinosus** originates from the **ischial tuberosity**, sharing a common origin with the long head of the biceps femoris. - It is also a **hamstring muscle**. *Adductor magnus* - The **adductor magnus** has a dual origin; its adductor (anterior) part originates from the **inferior pubic ramus** and **ischial ramus**, while its hamstring (posterior) part originates directly from the **ischial tuberosity**. - Its origin is therefore partially from the ischial tuberosity, making it an incorrect answer for the "except" question.

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: The blood supply of the anterior cruciate ligament (ACL) is primarily derived from?

Middle genicular artery. ***Middle genicular artery*** - This artery, a branch of the **popliteal artery**, is the **primary blood supply** to the ACL and PCL. - It directly penetrates the **posterior capsule of the knee joint** to reach the cruciate ligaments. *Descending genicular artery* - This artery, a branch of the **femoral artery**, primarily supplies the **vastus medialis muscle** and the medial aspect of the knee joint. - It does not directly contribute significantly to the **intraligamentous blood flow** of the ACL. *Circumflex fibular artery* - This artery typically branches from the **posterior tibial artery** or the **fibular artery**. - It supplies structures in the **proximal leg** around the fibular head, not the cruciate ligaments within the knee joint. *Superior medial genicular artery* - This artery is one of the five genicular branches of the **popliteal artery**. - It primarily supplies the **medial epicondyle of the femur**, the **medial collateral ligament**, and the **medial head of the gastrocnemius**, with minimal contribution to the ACL.

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: Anterior gliding of the tibia on the femur is prevented by

Anterior cruciate ligament. ***Anterior cruciate ligament*** - The **anterior cruciate ligament (ACL)** is a crucial stabilizer of the knee joint, preventing the **anterior translation of the tibia** relative to the femur. - It also limits **hyperextension** and internal rotation of the tibia. *Posterior cruciate ligament (PCL)* - The **PCL** primarily prevents posterior displacement or **gliding of the tibia** on the femur. - It is often injured by direct trauma to the anterior tibia or through vehicular accidents. *Ligament of Humphrey* - The **ligament of Humphrey** is an accessory ligament of the knee that runs anterior to the **posterior cruciate ligament (PCL)**. - It arises from the posterior horn of the lateral meniscus and inserts into the medial femoral condyle, potentially augmenting PCL function. *Ligament of Wrisberg* - The **ligament of Wrisberg** is another accessory ligament that runs posterior to the **posterior cruciate ligament (PCL)**. - It also originates from the posterior horn of the lateral meniscus and inserts into the medial femoral condyle, serving a similar function to the ligament of Humphrey in stabilizing the knee.

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.

Question 1

Which of the following statements accurately describes the location of the saphenous vein?

Accepted Answer

1cm anterior and 1cm superior to the medial malleolus

Answer

1cm posterior to the medial malleolus

Answer

1cm inferior to the medial malleolus

Answer

1cm superior to the medial malleolus

Question 2

Muscles taking origin from the ischial tuberosity are all except:

Accepted Answer

Adductor longus

Answer

Semitendinosus

Answer

Adductor magnus

Answer

Semimembranosus

Question 3

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 4

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 5

The blood supply of the anterior cruciate ligament (ACL) is primarily derived from?

Accepted Answer

Middle genicular artery

Answer

Descending genicular artery

Answer

Circumflex fibular artery

Answer

Superior medial genicular artery

Question 6

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 7

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 8

Anterior gliding of the tibia on the femur is prevented by

Accepted Answer

Anterior cruciate ligament

Answer

Ligament of Humphrey

Answer

Ligament of Wrisberg

Answer

Posterior cruciate ligament

Question 9

Abduction of the thigh is limited by:

Accepted Answer

Pubofemoral ligaments

Answer

Ischiofemoral ligaments

Answer

Iliofemoral ligaments

Answer

Sacroiliac ligament

Question 10

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

Lower Limb — MCQs

Lower Limb — MCQs

On this page

Practice by Chapter

Want unlimited practice?