Lower Limb — MCQs

Lower Limb Indian Medical PG Practice Questions and MCQs

Question 461: Injury to which part causes difficulty in dorsiflexion of the foot?

A. B (Correct Answer)
B. D
C. C
D. A

Explanation: ***B*** - This arrow points to the **head and neck of the fibula**. The **common fibular (peroneal) nerve** wraps around the fibular neck, making it susceptible to injury in this location. - Damage to the common fibular nerve results in paralysis of the muscles in the anterior and lateral compartments of the leg, leading to **foot drop**, which is the inability to dorsiflex and evert the foot. *A* - This arrow points to the **medial condyle of the femur**. Injury to this area typically affects the knee joint, potentially damaging ligaments like the MCL or the medial meniscus. - It does not directly involve the nerves responsible for foot dorsiflexion, which are located more laterally and distally. *C* - This arrow indicates the **shaft of the femur**. A fracture of the femoral shaft is a severe injury but does not typically cause isolated difficulty with foot dorsiflexion. - Foot drop could occur if the **sciatic nerve** is injured proximally in the thigh, but this would result in a more widespread neurological deficit affecting both plantarflexion and dorsiflexion. *D* - This arrow points to the **lateral condyle of the femur**. Similar to the medial condyle, an injury here would primarily compromise the structures of the knee joint itself, such as the LCL or lateral meniscus. - The course of the common fibular nerve is posterior to the lateral femoral condyle before it wraps around the fibular neck, so an isolated condylar fracture is unlikely to cause foot drop.

Question 462: Identify the bone indicated by the arrow in the image.

A. Intermediate cuneiform
B. Lateral cuneiform
C. Navicular (Correct Answer)
D. Cuboid

Explanation: ***Navicular*** - The arrow points to the navicular bone, a key tarsal bone located on the **medial side** of the foot. It articulates proximally with the **talus** and distally with the three **cuneiform** bones. - Its characteristic boat-like shape is identifiable on this AP radiograph, and it serves as the keystone of the **medial longitudinal arch** of the foot. *Cuboid* - The **cuboid** bone is located on the **lateral side** of the foot, articulating proximally with the **calcaneus** and distally with the fourth and fifth metatarsals. The indicated bone is medial. - The cuboid has a more cubical shape, which differentiates it from the scaphoid or boat-like shape of the navicular. *Intermediate cuneiform* - The **intermediate cuneiform** is located **distal** to the navicular bone and proximal to the base of the second metatarsal. The arrow points to a more proximal bone. - It is situated between the medial and lateral cuneiforms, forming part of the transverse arch of the foot. *Lateral cuneiform* - The **lateral cuneiform** is also located **distal** to the navicular, articulating with the third metatarsal. The arrow indicates the bone proximal to the cuneiform row. - It articulates with the intermediate cuneiform medially and the cuboid bone laterally, which is inconsistent with the indicated structure.

Question 463: A surgical procedure is performed on the great saphenous vein, around 2.5 cm anterior to the medial malleolus. Which of the following structures is most likely to be injured?

A. Tibial nerve
B. Deep peroneal nerve
C. Sural nerve
D. Saphenous nerve (Correct Answer)

Explanation: ***Saphenous nerve***- The **saphenous nerve**, a terminal cutaneous branch of the femoral nerve, accompanies the **great saphenous vein (GSV)** throughout the length of the leg on the medial side.- It crosses the ankle just anterior to the medial malleolus, lying immediately adjacent to the GSV, making it highly susceptible to injury during surgical procedures like GSV cannulation, harvesting, or varicose vein surgery in this region.*Sural nerve*- The **sural nerve** is located laterally, typically accompanying the **small saphenous vein (SSV)**, and runs behind the **lateral malleolus**.- Therefore, it is anatomically distant from the surgical site located anterior to the medial malleolus.*Deep peroneal nerve*- The **deep peroneal nerve** is located deep within the **anterior compartment** of the leg and supplies the muscles of the anterior compartment.- Although its terminal branches cross the dorsum of the foot, it is not directly associated with the superficial GSV or the medial malleolus in a manner that would predispose it to injury during this specific superficial procedure.*Tibial nerve*- The **tibial nerve** passes through the **tarsal tunnel**, located deep and posterior (behind) the **medial malleolus**.- This nerve supplies the posterior compartment muscles and is deep to the fascia, making it unlikely to be injured during a superficial procedure performed 2.5 cm *anterior* to the medial malleolus.

Question 464: What is the action of the muscle marked in the image?

A. Internal rotation
B. Knee flexion
C. Knee extension
D. Hip abduction (Correct Answer)

Explanation: ***Hip abduction*** - The image displays the **gluteus medius** muscle, whose primary action is to **abduct** the thigh at the hip joint. - This muscle is crucial for stabilizing the pelvis during the gait cycle; weakness leads to a positive **Trendelenburg sign**. ***Internal rotation*** - While the anterior fibers of the **gluteus medius** contribute to internal rotation, it is not its primary function. - The primary internal rotators of the hip are the **gluteus minimus** and the **tensor fasciae latae**. ***Knee extension*** - The **gluteus medius** does not cross the knee joint and therefore has no action on knee extension. - Knee extension is the primary function of the **quadriceps femoris** muscle group, located in the anterior thigh. ***Knee flexion*** - The **gluteus medius** does not act on the knee joint, so it cannot cause knee flexion. - Knee flexion is primarily performed by the **hamstring muscles** (biceps femoris, semitendinosus, and semimembranosus) located in the posterior thigh.

Question 465: Which muscles are supplied by the superficial peroneal nerve?

A. Both A & C
B. Peroneus longus & Brevis (Correct Answer)
C. Extensor hallucis longus
D. Peroneus tertius

Explanation: ***Peroneus longus & Brevis*** - The **superficial peroneal nerve** (superficial fibular nerve) supplies **only two muscles**: **Peroneus longus** and **Peroneus brevis** - These muscles form the **lateral compartment of the leg** - They function primarily in **ankle eversion** and contribute to **plantar flexion** - The superficial peroneal nerve is a terminal branch of the **common peroneal nerve** that arises at the neck of the fibula *Incorrect - Both A & C* - This option incorrectly combines different muscle groups - Option C refers to muscles supplied by the **deep peroneal nerve**, not the superficial peroneal nerve *Incorrect - Extensor hallucis longus* - This muscle is located in the **anterior compartment** of the leg - It extends the great toe and assists in ankle dorsiflexion - It is innervated by the **deep peroneal nerve**, NOT the superficial peroneal nerve *Incorrect - Peroneus tertius* - This muscle belongs to the **anterior compartment** despite its name - It acts as a dorsiflexor and evertor of the foot - It is supplied by the **deep peroneal nerve**, NOT the superficial peroneal nerve - The superficial peroneal nerve only supplies the lateral compartment muscles (Peroneus longus and brevis)

Question 466: A patient presents with meralgia paresthetica. Based on the diagram, identify the nerve involved in this condition.

A. A
B. B
C. C (Correct Answer)
D. D

Explanation: ***C (Lateral Femoral Cutaneous Nerve)*** - Meralgia paresthetica is an entrapment neuropathy caused by compression of the **Lateral Femoral Cutaneous Nerve (LFCN)**, which corresponds to C in the diagram and arises from **L2 and L3** roots. - Compression usually occurs as the nerve passes under the **inguinal ligament**, resulting in pain, numbness, and tingling over the **anterolateral thigh**. *A (Ilioinguinal/Iliohypogastric Nerve)* - Nerve A, usually the Ilioinguinal or Iliohypogastric nerve (T12, L1), innervates the **inguinal region** and lower abdominal wall. - Entrapment of these nerves results in pain radiating towards the **groin** or superior thigh, not the characteristic distribution of meralgia paresthetica. *B (Genitofemoral Nerve)* - Nerve B is the **Genitofemoral nerve** (L1, L2), which supplies sensation to the superior medial thigh and genitalia. - Injury results in loss of the **cremasteric reflex** and sensory changes in the scrotal/labial and proximal anterior thigh area. *D (Femoral Nerve)* - Nerve D is the large **Femoral Nerve** (L2-L4), responsible for motor supply to the **quadriceps** and sensation to the anterior thigh and medial leg. - Compression typically causes prominent **quadriceps weakness** (difficulty extending the knee) in addition to sensory loss, unlike the purely sensory presentation of meralgia paresthetica.

Question 467: Which is correct about the markings shown on the left popliteal fossa? (Recent NEET Pattern 2016-17)

A. 1 = Tibial nerve, 2= popliteal vein, 3= popliteal artery, 4= Semitendinosus
B. 1 = Popliteal artery, 2= popliteal vein, 3= tibial nerve, 4= Semitendinosus
C. 1 = Tibial nerve, 2= popliteal vein, 3= popliteal artery, 4= Semimembranosus
D. 1 = Popliteal artery, 2= popliteal vein, 3= tibial nerve, 4= Semimembranosus (Correct Answer)

Explanation: ***1 = Popliteal artery, 2= popliteal vein, 3= tibial nerve, 4= Semimembranosus*** - In the popliteal fossa, the **popliteal artery** is the deepest and most medial structure, followed by the **popliteal vein** and then the **tibial nerve** superficially. - The **semimembranosus** muscle forms part of the superomedial boundary of the popliteal fossa. *1 = Tibial nerve, 2= popliteal vein, 3= popliteal artery, 4= Semitendinosus* - This option incorrectly identifies the deepest structure as the tibial nerve and mislabels the superficial aspect of the neurovascular bundle. - The muscle labeled 4 is too broad and flat to be the semitendinosus, which is more slender and located superficial to the semimembranosus. *1 = Popliteal artery, 2= popliteal vein, 3= tibial nerve, 4= Semitendinosus* - While the first three structures are correctly identified in their relative positions, the muscle labeled 4 does not correspond to the **semitendinosus**. - The **semitendinosus** would be a more superficial and narrower muscle in this region. *1 = Tibial nerve, 2= popliteal vein, 3= popliteal artery, 4= Semimembranosus* - This option incorrectly identifies the **tibial nerve** as the deepest structure in the popliteal fossa. - The correct order from deep to superficial in the neurovascular bundle is artery, vein, then nerve.

Question 468: Identify the bone marked as X.

A. Cuboid (Correct Answer)
B. Navicular
C. Cuneiform
D. Calcaneus

Explanation: ***Cuboid*** - The cuboid bone is a **tarsal bone** located on the **lateral side of the foot**, distal to the calcaneus and proximal to the fourth and fifth metatarsals, which matches the position of X in the image. - It articulates with the **calcaneus**, **lateral cuneiform**, and the bases of the **fourth and fifth metatarsal bones**. *Navicular* - The navicular bone is located on the **medial side of the foot**, distal to the talus and proximal to the three cuneiform bones. - The bone marked X is on the lateral side of the foot, making the navicular an incorrect identification. *Cuneiform* - There are three cuneiform bones (**medial, intermediate, and lateral**), located between the navicular and the first, second, and third metatarsals on the medial aspect of the foot. - The bone marked X is more lateral and articulates with the fourth and fifth metatarsals, not the first three. *Calcaneus* - The calcaneus is the **largest tarsal bone**, forming the **heel** of the foot and lying posterior to the cuboid and navicular bones. - The bone marked X is positioned in the midfoot region, distinctly anterior to where the calcaneus would be.

Question 469: Femoral hernias are more common in females because :

A. femoral canal is long
B. femoral canal is wide (Correct Answer)
C. ligaments of femoral canal neck are weak
D. weakness of posterior inguinal wall

Explanation: ***femoral canal is wide*** - Females tend to have a **wider pelvis** to accommodate childbirth, which consequently leads to a proportionally wider and shorter femoral canal. - A wider femoral canal provides less structural support, making it easier for abdominal contents to herniate through the **femoral ring** [1]. *femoral canal is long* - The length of the femoral canal is not the primary factor influencing the predisposition to femoral hernias in females. - A longer canal might theoretically offer more resistance to herniation if its diameter were consistent. *ligaments of femoral canal neck are weak* - While ligamentous laxity can contribute to hernia formation, the primary anatomical reason for the increased incidence in females is the **wider canal**, not inherently weaker ligaments specific to the femoral canal neck. - The **inguinal ligament** forms the anterior boundary of the femoral ring, and its integrity is important, but its weakness isn't the direct cause of female predisposition. *weakness of posterior inguinal wall* - Weakness of the posterior inguinal wall is more directly associated with **direct inguinal hernias**, which are distinct from femoral hernias [1]. - Femoral hernias protrude below the inguinal ligament, through the femoral canal, rather than through the inguinal canal itself.

Question 470: Match List-I with List-II and select the correct answer using the code given below the Lists: (Refer to the image below for the lists)

A. A→4 B→3 C→1 D→2
B. A→3 B→2 C→4 D→1
C. A→4 B→3 C→2 D→1 (Correct Answer)
D. A→3 B→2 C→1 D→4

Explanation: ***A→4 B→3 C→2 D→1*** - **Atrial fibrillation** is characterized by **irregularly irregular rhythm** without distinct P waves, making the R-R interval highly variable. It is a supraventricular tachyarrhythmia, originating above the ventricles. - **Ventricular tachycardia** typically presents with a **wide QRS complex** (>0.12 s) and a **rapid, regular heart rate**, as it originates from the ventricles. - **Complete heart block** is characterized by complete dissociation between **P waves and QRS complexes**, meaning the atria and ventricles beat independently. This is reflected in an irregular P-P interval and a regular but slower R-R interval often due to an escape rhythm. - **Ventricular fibrillation** is an ECG emergency characterized by chaotic, **irregular electrical activity** and an absence of discernible P waves, QRS complexes, or T waves, leading to cardiac arrest. *A→4 B→3 C→1 D→2* - This option correctly matches A (Atrial fibrillation) with 4 (Irregular R-R interval without P waves) and B (Ventricular tachycardia) with 3 (Wide QRS complexes and regular rapid rate). However, it incorrectly matches C (Complete heart block) with 1 (Chaotic rhythm) and D (Ventricular fibrillation) with 2 (Dissociation of P and QRS waves). - **Complete heart block** involves **dissociation of P and QRS waves**, and **Ventricular fibrillation** is defined by a **chaotic rhythm**, not the other way around as suggested by C→1 and D→2. *A→3 B→2 C→4 D→1* - This option incorrectly matches A (Atrial fibrillation) with 3 (Wide QRS complexes and regular rapid rate), which describes ventricular tachycardia. - It also incorrectly matches C (Complete heart block) with 4 (Irregular R-R interval without P waves) and D (Ventricular fibrillation) with 1 (Chaotic rhythm), instead of the correct associations. *A→3 B→2 C→1 D→4* - This option incorrectly matches A (Atrial fibrillation) with 3 (Wide QRS complexes and regular rapid rate) which is characteristic of ventricular tachycardia. - It also incorrectly matches B (Ventricular tachycardia) with 2 (Dissociation of P and QRS waves), which is a characteristic of complete heart block, not ventricular tachycardia.

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Gluteal Region and Hip

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Thigh and Popliteal Fossa

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Leg and Foot

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Joints of Lower Limb

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Nerves of Lower Limb

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Arterial Supply and Venous Drainage

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Lymphatic Drainage

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Muscles and Their Actions

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Gait Analysis and Biomechanics

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Applied Anatomy and Clinical Correlations

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Lower Limb — MCQs

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