Lower Limb Practice Questions

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

B. ***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.

Q: Identify the bone indicated by the arrow in the image.

Navicular. ***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.

Q: 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?

Saphenous nerve. ***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.

Q: What is the action of the muscle marked in the image?

Hip abduction. ***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.

Q: Which muscles are supplied by the superficial peroneal nerve?

Peroneus longus & Brevis. ***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)

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

C. ***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.

Q: Identify the bone marked as X.

Cuboid. ***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.

Q: Femoral hernias are more common in females because :

femoral canal is wide. ***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 1

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

Accepted Answer

B

Answer

D

Answer

C

Answer

A

Question 2

Identify the bone indicated by the arrow in the image.

Accepted Answer

Navicular

Answer

Intermediate cuneiform

Answer

Lateral cuneiform

Answer

Cuboid

Question 3

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?

Accepted Answer

Saphenous nerve

Answer

Tibial nerve

Answer

Deep peroneal nerve

Answer

Sural nerve

Question 4

What is the action of the muscle marked in the image?

Accepted Answer

Hip abduction

Answer

Internal rotation

Answer

Knee flexion

Answer

Knee extension

Question 5

Which muscles are supplied by the superficial peroneal nerve?

Accepted Answer

Peroneus longus & Brevis

Answer

Both A & C

Answer

Extensor hallucis longus

Answer

Peroneus tertius

Question 6

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

Accepted Answer

C

Answer

A

Answer

B

Answer

D

Question 7

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

Accepted Answer

1 = Popliteal artery, 2= popliteal vein, 3= tibial nerve, 4= Semimembranosus

Answer

1 = Tibial nerve, 2= popliteal vein, 3= popliteal artery, 4= Semitendinosus

Answer

1 = Popliteal artery, 2= popliteal vein, 3= tibial nerve, 4= Semitendinosus

Answer

1 = Tibial nerve, 2= popliteal vein, 3= popliteal artery, 4= Semimembranosus

Question 8

Identify the bone marked as X.

Accepted Answer

Cuboid

Answer

Navicular

Answer

Cuneiform

Answer

Calcaneus

Question 9

Femoral hernias are more common in females because :

Accepted Answer

femoral canal is wide

Answer

femoral canal is long

Answer

ligaments of femoral canal neck are weak

Answer

weakness of posterior inguinal wall

Question 10

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)

Accepted Answer

A→4  B→3  C→2  D→1

Answer

A→4  B→3  C→1  D→2

Answer

A→3  B→2  C→4  D→1

Answer

A→3  B→2  C→1  D→4

Lower Limb — MCQs

Lower Limb — MCQs

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